Novel use of Steinman pin in removal of broken interlocking screws.
ABSTRACT Broken screws after interlocking nailing of long bones are commonly seen in Orthopaedic practice. Removal of such screws can be difficult particularly the distal part which is often held within the bone. We describe a simple technique of using Steinman pin to aid removal of broken screws in a case of non-union fracture tibia with broken interlocking nail and screws. Steinman pin being easily available and the reproducible technique make it a useful aid for removal of broken interlocking screws.
Article: Removal of broken hardware.[show abstract] [hide abstract]
ABSTRACT: Despite advances in metallurgy, fatigue failure of hardware is common when a fracture fails to heal. Revision procedures can be difficult, usually requiring removal of intact or broken hardware. Several different methods may need to be attempted to successfully remove intact or broken hardware. Broken intramedullary nail cross-locking screws may be advanced out by impacting with a Steinmann pin. Broken open-section (Küntscher type) intramedullary nails may be removed using a hook. Closed-section cannulated intramedullary nails require additional techniques, such as the use of guidewires or commercially available extraction tools. Removal of broken solid nails requires use of a commercial ratchet grip extractor or a bone window to directly impact the broken segment. Screw extractors, trephines, and extraction bolts are useful for removing stripped or broken screws. Cold-welded screws and plates can complicate removal of locked implants and require the use of carbide drills or high-speed metal cutting tools. Hardware removal can be a time-consuming process, and no single technique is uniformly successful.The Journal of the American Academy of Orthopaedic Surgeons 03/2008; 16(2):113-20. · 2.46 Impact Factor
Article: Broken intramedullary nails.[show abstract] [hide abstract]
ABSTRACT: Between 1962 and 1987, we treated fifty-six patients for sixty broken intramedullary nails, using a custom-made hook to extract the distal fragment of the nail. The charts and radiographs of all of the patients were reviewed. Thirty-nine of the nails had been inserted in a fresh fracture, which usually was comminuted; eight had been used for fixation of an osteotomy; nine, for fixation of a non-union; and four, for treatment of a pathological fracture. Several small-diameter intramedullary nails broke at the site of the fracture or non-union. In contrast, the sites of breakage in the interlocking nails were the interlocking holes and the welded junction of the top insertional portion and the proximal slot. Many of the breakages were in patients who had an unstable fracture pattern. The interval between insertion and breakage ranged from one to 120 months.The Journal of Bone and Joint Surgery 01/1989; 70(10):1463-71. · 3.23 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: We report a simple alternative procedure, modified ball-tipped guide wires technique, to remove a broken long gamma nail at the level of lag screw hole which is detected during a removal procedure. The fragment retained in the medullary canal was successfully removed without complication.The Journal of trauma 03/2008; 64(2):517-9. · 2.35 Impact Factor
Page 1 of 2
(page number not for citation purposes)
Novel use of Steinman pin in removal of broken interlocking screws
Kiran Singisetti* and George P Ashcroft
Address: Department of Orthopaedics, Woodend Hospital, Eday Road, Aberdeen, AB15 6XS, UK
Email: Kiran Singisetti* - email@example.com; George P Ashcroft - firstname.lastname@example.org
* Corresponding author
Broken screws after interlocking nailing of long bones are commonly seen in Orthopaedic practice.
Removal of such screws can be difficult particularly the distal part which is often held within the
bone. We describe a simple technique of using Steinman pin to aid removal of broken screws in a
case of non-union fracture tibia with broken interlocking nail and screws. Steinman pin being easily
available and the reproducible technique make it a useful aid for removal of broken interlocking
Broken interlocking screws are not an unusual problem in
Orthopaedic practice and its causes can be varied [1,2].
While it is relatively easier to remove the head end of the
screw with a screw-driver, it is difficult to remove the distal
(tip end) part of the broken screw held within the bone.
We describe a simple technique, with the use of Steinman
pin to aid removal of such screws.
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 fix-
ation of the fracture required removal of the original
metal work in situ, including the broken interlocking
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 1. After checking the position using image intensi-
fier the pin was struck with a mallet until the broken screw
fragment is driven out of the bone 2. This part of the screw
was then fished out from the soft tissues through a sepa-
rate incision once it had been disimpacted from the nail
and bone 3. Care should be taken to avoid damage of neu-
rovascular structures while attempting removal of such
Several techniques and methods have been described for
removal of broken interlocking nails and screws [2,3]. The
simple and reproducible procedure of disimpacting the
broken screws and easy availability of Steinman pin in
operation theatres makes our technique practical to use.
Written informed consent was obtained from the patient
for publication of this case report and accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
Published: 17 November 2008
Cases Journal 2008, 1:317 doi:10.1186/1757-1626-1-317
Received: 14 August 2008
Accepted: 17 November 2008
This article is available from: http://www.casesjournal.com/content/1/1/317
© 2008 Singisetti and Ashcroft; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cases Journal 2008, 1:317http://www.casesjournal.com/content/1/1/317
Page 2 of 2
(page number not for citation purposes)
KS was involved with the initial writing of the manuscript
including the literature search. GA is the senior author
who described and used the technique. He also reviewed
the article and suggested final changes before submission.
1.Franklin J, Winquist R, Benirschke S, Hansen S: Broken intramed-
ullary nails. J Bone Joint Surg – Am 1988, 70:1463-1471.
2.Hak DJ, McElvany M: Removal of broken hardware. J Am Acad
Orthop Surg 2008, 16(2):113-20. Review
3.Riansuwan K, Carter C, Nercessian O: Removal of broken long
gamma nail: a modified guide wires technique. J Trauma 2008,
Image intensifier film to show broken screw with Steinman pin insertion
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 disimpaction of broken
screw from bone.
Image intensifier film to show removal of broken screw from soft tissues
Image intensifier film to show removal of broken
screw from soft tissues.