New method to remove a broken guide pin in the hip joint.

Removing a broken guide wire is difficult and challenging. This article reports a method that was used to successfully remove a broken guide wire in 3 patients who underwent operative treatment for intertrochanteric fractures of the femur. Under general anesthesia, the first patient was placed on the orthopedic fracture table, and closed reduction of the hip fracture was performed under the image intensifier. A 2-mm non-threaded pin was used in the center of the femoral neck, and the amount of reaming required was determined. The reaming proceeded without any difficulty until the reamer failed to progress, which was attributed to the presence of a sclerotic or calcar region. Under fluoroscopy, on an anteroposterior view, the pin was parallel with the reamer; however, the authors failed to check the lateral image. After reaming through the hard tissue, the reamer suddenly passed through easily. On checking under the scope, it was noted that the pin was broken. The tip of the pin passed the acetabulum but did not enter the pelvis. Efforts to remove the broken pin failed. An attempt to reach the pin using a dynamic hip screw reamer also failed. Ultimately, the broken pin was removed using a 2-mm cannulated drill bit under fluoroscopy. After the experience with the first patient, in the other 2 cases, the authors used a cannulated drill bit to avoid any extensive reaming and trauma to the tissues. With this method, the authors were able to remove the broken pin easily in a few minutes. Copyright 2011, SLACK Incorporated.