Failed Removal of Fracture Nail: What to Do Next?

Failed removal of fracture fixation nails?

Last July, I slipped and suffered a closed fracture of the right humerus.
The doctor fixed it with a steel nail.
Last month, the doctor informed me that I could have the nail removed.
On July 22, the nail was removed, but only the head of the nail and the first two threads were visible.
The doctor said the nail had broken, and if it needed to be removed from inside the bone, the bone would have to be drilled out.
What should I do? The doctor told me that it was okay for the broken nail to remain inside the bone and that it wouldn't deteriorate, but shouldn't this be considered a medical error? Will the steel nail inside the bone cause any issues?

vanness, 10~19 year old female. Ask Date: 2011/08/10

Dr. Li Wenlin reply Orthopedics

Please don't worry.
Your attending physician is indeed correct.
When removing internal fixation, there may be instances of broken screws.
If it is assessed that removing the screws would require sacrificing too much bone (not necessarily needing to break it), the attending physician will usually opt not to sacrifice excessive bone.
A broken screw left in the body will not cause any problems and will not deteriorate.
The only downside of leaving a screw in the bone is that if the same bone fractures again, the screw occupies some space, and during surgery, care must be taken to avoid the broken screw.
However, the likelihood of a person fracturing the same bone twice in their lifetime is very low, so there is no need to worry.
Wishing you all the best! Li Wenlin

Reply Date: 2011/08/10

More Info

When faced with the situation of a failed removal of a fracture nail, it’s essential to understand both the implications of leaving the broken nail in place and the potential next steps for treatment. In your case, the situation involves a broken intramedullary nail that was intended to stabilize your humeral fracture. The fact that only part of the nail was removed, leaving the remaining portion embedded in the bone, raises several concerns and considerations.

Understanding the Situation
1. Medical Context: Intramedullary nails are commonly used to stabilize long bone fractures. They are designed to promote healing by providing internal support. However, complications can arise during removal, such as the nail breaking. In your case, the doctor indicated that the remaining part of the nail would not cause harm and would not degrade over time. This is generally true; most modern orthopedic implants are made from biocompatible materials that resist corrosion and do not adversely affect bone healing.

2. Potential Risks: While the remaining nail may not pose an immediate risk, there are potential long-term considerations. If the broken piece of the nail is causing pain, discomfort, or impeding the normal function of the arm, it may need to be addressed. Additionally, if there is any risk of infection or if the nail is interfering with future surgical interventions, these factors would necessitate further action.

Next Steps
1. Monitoring: Your doctor may recommend a period of observation to monitor for any signs of complications, such as pain, swelling, or signs of infection. Regular follow-up appointments with imaging studies (like X-rays) can help assess the situation over time.

2. Consultation with an Orthopedic Specialist: If you have concerns about the broken nail, it may be beneficial to seek a second opinion from another orthopedic surgeon. They can provide additional insights into whether the remaining portion of the nail should be removed or if it can safely remain in place.

3. Surgical Options: If the decision is made to remove the remaining portion of the nail, this would typically involve a surgical procedure. The surgeon would likely need to access the bone through an incision, and in some cases, they may need to use specialized tools to extract the broken piece. This procedure may involve additional risks, including infection, nerve damage, or complications related to anesthesia.

4. Rehabilitation: Regardless of whether the nail is removed or left in place, rehabilitation will be crucial. Physical therapy can help restore strength and range of motion in your arm, which may have been affected by the initial injury and the presence of the nail.

Addressing Concerns of Medical Negligence
You mentioned concerns about medical negligence regarding the broken nail. While it is understandable to feel frustrated, it’s important to note that complications can occur in any surgical procedure, and not all complications are due to negligence. If you believe that the standard of care was not met, you may want to consult with a legal professional who specializes in medical malpractice to discuss your options.

Conclusion
In summary, while the broken portion of the fracture nail may not pose an immediate threat, it is essential to monitor the situation closely. Consulting with an orthopedic specialist for a second opinion can provide clarity on the best course of action. Whether the remaining nail is left in place or surgically removed, a comprehensive rehabilitation plan will be vital for your recovery. Always feel empowered to ask questions and seek clarity from your healthcare providers regarding your treatment options and any concerns you may have.

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