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intramedullary cortical fragment, nailing, incarcerated free fragment
Intramedullary nailing of long bones is a safe procedure, with excellent long-term results. Even in apparently simple fractures, many complications may arise. Incarceration of a cortical fragment in the medullary canal is a fearsome situation, which may lead to severe complications and, consequently, poor outcomes. The surgeon should be aware of this risk and, after careful analysis of the pre-operative imaging, must remove or, at least, disengage the fragment from the medullary canal.
2. Berg EE. Technical problems caused by comminuted cortical free fragments during intramedullary rodding: case reports. J Trauma. 1994 May;36(5):749-51. doi: 10.1097/00005373-199405000-00029. PMID: 8189483
3. Nag S, Lall H, Jain VK, Bansal P, Khare R, Mittal D. Intramedullary bone fragment obstructing passage of reaming guide wire with iatrogenic fractured tibia. Orthopedics. 2010 Feb;33(2):119-21. doi: 10.3928/01477447-20100104-24. PMID: 20192151.
4. Rainer W, Hake ME, Mauffrey C, Hak DJ. Intramedullary cortical fragments: Recognition and techniques to permit safe nailing. Injury. 2015 Dec;46(12):2502-6. doi: 10.1016/j.injury.2015.08.019. Epub 2015 Aug 19. PMID: 26319207.
5. Rajappa S, Kumar NS. Unusual complication following intramedullary nailing of tibia: a case report. Cases J. 2009 Sep 14;2:7343. doi: 10.4076/1757-1626-2-7343. PMID: 19918520; PMCID: PMC2769350.
6. M. Rodger, R. Atkins. Intra-articular fragment extrusion during tibialintramedullary nailing. Injury Extra (2008)39, 134-136
7. Salamon M, Finkemeier CG. Intramedullary bone fragment preventing passage of reaming guide wire. Am J Orthop (Belle Mead NJ). 2007 Sep;36(9):492-3. PMID: 17948154
8. Sabat D, Wangchuk T, Dhal A. Inadvertent advancement of guide wire across the knee caused by incarcerated bone fragment at the nail tip during femoral nailing. Chin J Traumatol. 2014 Apr 1;17(2):118-20. PMID: 24698584