Transtrochanteric Removal of Infected Retrograde Femoral Nails in Osteomyelitis of the Femur: A New Technique

The use of retrograde intramedullary nailing in fractures of the femur has become widely accepted in the treatment of trauma patients. The indications for retrograde nailing are continuously expanding and include supracondylar femoral fractures, ipsilateral femoral neck and shaft fractures, bilateral femoral fractures, ipsilateral femoral shaft and tibial shaft fractures, femoral shaft fractures below a total hip arthroplasty or above a total knee arthroplasty, ipsilateral femoral shaft and acetabular fractures, and patient obesity.(1-8)There is a paucity of literature regarding removal of retrograde intramedullary femoral nails. The indications for removal include nonunion, malunion, knee pain, local pain at the screws sites, infection, and hardware failure.(9)Arthroscopy-assisted removal of retrograde intramedullary femoral nails was described by Born et al.(10) and Gebhard et al.,(11) but this technique may be involved with further damage to the knee joint and, in the case of an infected implant, may induce contamination of the knee. The use of a transtrochanteric technique allows prudent removal of the nail and is particularly useful in cases of implant infection. We have used this technique in a patient with osteomyelitis of the femur after retrograde nailing after a supracondylar fracture.