Journal of Musculoskeletal Trauma

Segmental Breakage of Distal Interlocking Screw Complicating removal of broken nail: A Case Report: Kyu Hyun Yang, Seong Jin Park, Hyung Jung Kim; J Korean Soc Fract 2000;13(4):709-712. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.709

Abstract PDF: Metal failure (nail breakage) after locked intramedullary nailing results from delayed union or nonunion, which necessitates removal of nail and interlocking screws. Breakage of interlocking screw(s) can be associated with failure of the intramedullary nail. It usually breaks into two parts. Proximal part, which contains the screw head, can be removed by screwdriver without difficulties. Distal part can be removed from the far cortex or be left in place if it does not hinder further procedures. We experienced a case of segmental breakage of distal interlocking screw, which was associated with failure of the femoral nail and nonunion. Middle part of the broken screw obstructed the hollow of the nail and complicated the removal of the broken nail.

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Breakage of Interlocking Screw after Intramedullary Nailing of Femoral Shaft Fracture: Gun Il Im, Cheol Won Hyun, Joo Ho Shin, Do Young Kim, Won Ho Cho; J Korean Soc Fract 2000;13(3):463-469. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.463

Abstract PDF: PURPOSE
We analysed risk factors for failure of interlocking screws after femoral intramedullary nailing, and introduce tips for removing broken screw.
MATERIALS AND METHODS
Seventy-two closed femoral shaft fractures were treated with interlocking nail. We compared 7 patients in whom interlocking screw breakage occurred (Group I) with 65 patients without breakage of interlocking screw (Group II). Analytic parameters were age, weight, level of fracture, degree of comminution, nail diameter. We used Mann-Whitney U test & Chi-sqare test for statistical analysis.
RESULT
Upper one of distal interlocking screws was broken in 6 patients, both of distal screws were broken in one patient. All of the patients with broken screws had associated delayed union. The mean age of patients were 20 years in group I, 31 years in group II. The mean weight were 69.6 Kg in group I, 62.02kg in group II. Three patients had fractures in proximal half and four patients had fractures in distal half in group I. In group II, there were 25 proximal fractures and 40 distal fractures. There were 2 type I, 2 type II, 1 type III, 2 type IV fractures in group I, and 16 type I, 31 type II, 17 type III, 1 type IV fractures according to Winquist and Hansen classification. Nail diameters were 10mm in 4 patients, 11mm in 2 patients, 12mm in 1 patient for group I and 10mm in 8 patients, 11mm in 13 patients, 12mm in 25 patients, 13mm in 13 patients, and 14mm in 6 patients for group II. Age, weight, degree of comminution, nail diameter had statistically significant relation to the breakage of interlocking screw(p<0.05), but the level of fracture didn't(p>0.05). Broken screws were easily removed by advancing screw to medial compartment with S-pin and making short medial incision.
CONCLUSION
It is suggested from our study that combination of parameters may have contributed to the failure of interlocking screw ; narrower diameter nail for comminuted fracture in young, active patients with more body weight. Inserting two screws have advantage over one screw.

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A Simplified Technique of Distal Locking Screw Fixation of Interlocking Nail: Young Bok Jung, Ki Ser Kang, Boo Sup Kim, Han Jun Lee, Whui Jae Jin; J Korean Soc Fract 1995;8(1):248-253. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.248

Abstract PDF: Failure to determine distal femoral screw hole position can sometimes prolong operating time for placing interlocking screw and increased radiation hazard. We attempted to assess progress in the insertion of distal locking screw with target device. Insertion method of distal locking screw in femoral nail that uses target device improved the accuracy of distal screw placement and reduced the radiation exposure. The authors analyzed 30 patients(33 cases) of the femur shaft fractures that treated by interlocking IM nailing using target divice in the Department of Orthpaedic Surgery, Chung-Ang university from August 1990 to July 1994. Among these patients, except 6 cases, all of the distal femoral drill holes attempted were successfully made with the first pass of a dirll without image intensiner monitoring. Compared with the commonly used free-hand method, our target divice assisted screw placement offer a reduction in the amount of time and radiation exposure to insert distal locking femoral screws.

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