A 46-year-old man was referred for leave chronic leg trouble. The patient was involved in a plane accident 30 years before sustaining a femoral rotating shaft fracture treated with a ream Kuntscher nail and a buttocks wall acetabulum fracture treated with open decrease and internal arrested development with slowdown screws ( ). The affected role came to our outpatient clinic complaining about inguinal annoyance and chronic leg pain with limit of activities of daily populate, although he was able to walk for more than one hour. On physical examination, the patient had no limitation of the hip range of motion. The ipsilateral knee had full scope of gesticulate and the patient did not need any crutches to walk without limping. Neurovascular examination was normal. The PostelMerléd ’ Aubigné scale was 14 points ( 4 for pain, 5 for walk and 5 for range of gesture ). overall alliance of the extremity was anatomic. As a part of the initial evaluation, a lineage test with infection parameters was performed and was damaging for infection. Pre-operative radiogram showed a bring around femoral fracture in all 4 cortices with an intramedullary Kuntscher nail without locking screws and cortical thicken at the fracture web site ( ).
The patient was informed about the incipient arthritis of the hip and the hypothesis to perform a one-stage or two-stage operation. The surgical risks were discussed with the patient, including trouble after hardware removal and failure to remove the nail, particularly this last point because other surgeons had tried to do the same routine few years before and had failed after many hours of surgery. The patient decided to have two-stage operation. first, remove the nail at all costs and depending on the consequence of this inaugural operation he would assess the hip successor surgery. The patient was put in a lateral position and a lateral hip approach was done. The beginning step was to find the proximal tip of the complete which was found seat trench in the great trochanter. The initial device used to remove the nail was the conic extraction instrument that was abortive after several attempts. After the giantism bone was removed of the proximal separate of the complete a hook extraction system was engaged with difficulty. however, the complete did not move after multiple hits with a 1 kilogram hammer and last the hook broke itself. At this point, we decided to use the see to perform a childlike unicortical osteotomy in the proximal third of the femur to decompress the endomedullar canal ( ). After this decompression osteotomy we tried to hit the collar from below with an impactor engaged in the proximal hole of the nail. however, the implant remained in the same position.
After trying all these different ways to remove the pinpoint being abortive, we decided to continue the longitudinal osteotomy from proximal to distal in the lateral side of the femur. The nail was found in set with on growth and giantism in about entire distance of the nail. A new try to hammer the nail from under was performed and the pinpoint started to move gradually until the proximal hole of the nail broke ( ). After sol many attempts, we did not give up and proceeded to drill a new trap distally with a diamond drill ( ) to finish the breeze through removal.
finally, the Kuntscher nail was removed in its entirety without any other complications. subsequently, respective cerclages and a bone homograft was used to close the longitudinal osteotomy ( ). The patient was admitted to the hospital for trouble and bleed control. On the second day of hospitalization insurance, the affected role underwent a blood transfusion as his hemoglobin was reported to be 7.1 g/dl. The affected role was discharged on day 4 after antibiotic prophylaxis, deep vein thrombosis prophylaxis with low-weight-molecular heparin and ambulation with crutches without system of weights behave. At 8 weeks of follow-up, patient was allowed to walk with gradual slant wear. The patient was satisfied at 1 class of follow-up with no complications and the x-ray showed complete healing of the longitudinal osteotomy ( ). At the time of this case report, the patient is free from annoyance in the leg with only sporadic hip annoyance, so there is no indication of pelvis refilling surgery for the meter being