Broken inrameduallry interlock nail in femur fracture. Implant has failed before union of fracture
Intramedullary interlocked nail is a very common implant used for treatment of diaphyseal fractures of long bones. It allows early mobilization of the limb owing to stable fixation. The implant is called interocked because screws are used on eitherside to lock the implant to the bone.
Implant failure is one of the problems associated with implant surgery. In this the impant metal gets fatigued before a fracture could have united. It is basically a race against time between fatigue of the implant and union of the fracture.
Two of the major causes of implant failure are poor implant [In terms of design, strength etc.] and poor surgical technique.
In the present image the implant has broken at the fracture site and the fracture has not united. The patient was 48 years old and the implant broke after 4 months of surgery.
Such cases require a resurgery where new implant is put after removal of the previous and bone grafting is done to stimulate the fracture healing.
Bone grafting is a procedure where bone slivers are harvested from the areas where bone can be taken like iliac crest.
This patient was treated with an exchange nailing and bone grafting.
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I am 60, female. I broke my femur near the knee about 8 months ago after a bad fall. At first the doctor put in a plate but the screws came loose and broke off after six months so it has now been replaced with a nail screwed in at the top and bottom. The screws are causing some discomfort but the doctor says union is proceeding well and we should wait another six weeks before considering removing the screws. I am thinking that it would be better to have a bit of discomfort than another operation (I have had three in the last eight months). Any suggestions?
Dr Arun Pal Singh Reply:
March 8th, 2010 at 12:33 pm
@Janet Shapiro,
Is there anything you want to know?