Abstract
Although endomedullary nailing is a reliable and quick method of treating long bone fractures, permitting an early load, it presents some risks and some problems due to rotational, flexion and compressions forces on its structure. In prematurely permitted loading, an operated limb that is not fully healed may be incompetent in weight-bearing and thus entirely supported by the nail, causing it to bend or break. We encountered this in two patients treated with a Kuntscher nail for femoral fracture who fell on the affected limb while walking on crutches after about 40 days after surgery. They suffered violent pain and a significant deformity of the limb in the area of the fracture. One patient was a 42-year-old man and the other a 19-year-old woman. A closed manipulation to straighten the bent nails according to the Patterson and Ramser method was performed in order to remove them and a guide-wire was introduced in the cavity of the nails during extraction. A new Kuntscher nail was inserted along the wire, shortening the time of operation and reducing the risks of X-ray exposure. Since it can be difficult to find the exact path along the medullary cavity when inserting a new nail and in order not to disturb the fracture healing, we recommend using a guide-wire as illustrated and not to ream the cavity.
