Extraction of broken interlocking tibial nail without opening the fracture - Nail in Nail technique: A simpler and cost effective solution

The removal of the distal fragment of broken intramedullary nail often poses an important technical challenge. Many methods have been published on the removal of the distal piece of a broken distal closed section intramedullary nail that involve the use of hooks, olive wires or special instruments that are often not available to the general orthopedist working in a smaller setup. Additionally, because it is difficult to remove the fragments using this approach, orthopedists performing the procedure may need to open the nonunion site in cases where opening the fracture site was not required. The authors have reported two cases of extraction of broken tibial interlocking nails using a novel technique without opening the fracture site using a long drill bit and a Talwalkar’s square radius nail. The technique has been explicitly described in the article and shall be of great use to the orthopaedicians working in smaller setups. It’s a simple procedure with minimal blood loss and has decreased the time of surgery. The authors have found this method quite easy, simple, and biological, hence does not add to the cost of treatment and should find a place in standard management of such cases.