A 28 year old male presented with increasing leg pain and disability after a previous interlocking nailing procedure for tibia shaft fracture. Radiographs of his leg showed the broken interlocking nail and screws in the tibia along with the non-union of fracture. To proceed with any revised fixation of the fracture required removal of the original metal work in situ, including the broken interlocking screws.
An appropriate incision was made over the screw and the head part of the broken screw removed after dissection. The blunt end of the Steinman pin was then passed down the screw track until it touched the broken end of retained screw . After checking the position using image intensifier the pin was struck with a mallet until the broken screw fragment is driven out of the bone . This part of the screw was then fished out from the soft tissues through a separate incision once it had been disimpacted from the nail and bone . Care should be taken to avoid damage of neurovascular structures while attempting removal of such screws.
Image intensifier film to show broken screw with Steinman pin insertion.
Image intensifier film to show disimpaction of broken screw from bone.
Image intensifier film to show removal of broken screw from soft tissues.