Difficulty in removal of certain intramedullary nails.

Intramedullary nailing is the most common treatment for displaced diaphyseal fractures of the femur and tibia. Gerhard Küntscher introduced the technique of intramedullary nailing to clinical practice in the 1940s, and this method has been the focus of many authors with regard to indications, technique, complications, and outcome. The five cases presented here represent a complication not often reported in recent years: the difficulty in removing an intact intramedullary nail. Inspection of the interlocking nails in four of the cases presented reveals a specific design characteristic: the cross sectional design of the nail prevents the distal, unslotted end of the nail from being extracted from the medullary cavity. This problem is preventable by a change in nail design or the development of absorbable implants.