Removal of Femoral Lengthening Nails

• Published in: Journal of the Pediatric Orthopaedic Society of North America Vol. 4; no. 2; p. 460
• Main Authors: Iobst, Christopher, Kold, Søren, Mikužis, Mindaugas
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2022
• ISSN: 2768-2765
• DOI: 10.55275/JPOSNA-2022-0031

“No surgeon ever looks good taking out hardware.” This simple statement illustrates the frustration many of us have felt when faced with an implant removal case. Since all internal lengthening nails are recommended for removal at the completion of treatment, any surgeon considering a patient for internal lengthening will eventually encounter a nail removal opportunity. As part of our limb reconstruction practices, the authors have removed hundreds of internal lengthening nails. We have developed techniques through trial and error over time to streamline and simplify the nail removal process. The goal of this article is to share our experience with you in the hopes that it makes your internal lengthening femoral nail removal surgery as smooth and painless as possible. •Do not remove all the interlocking fixation elements before securing the nail to the retrieval device.•Rotate the limb until the fixation elements are in profile under fluoroscopy. This will best determine if there is bone overgrowth that will prevent percutaneous removal of the interlocking elements.•Remove any bone or debris over the tip of the nail with a reamer. The reamer size should be at least 1 mm larger in diameter than the largest diameter of the nail to be retrieved.•For retrograde nail removal, a bump should be placed until the knee to create a straight, continuous line to the nail, where the patella is out of the path.