Intraoperative Femoral Shaft Fracture during Removal of a Zms Femoral Intramedullary Nail-A Case Report

Removing femoral intramedullary nail for a healed femur fracture is regarded as a low-risk procedure with little publications about its complications. We reported a case of a femoral shaft fracture which occurred while we were trying to remove the ZMS Femoral intramedullary nail from a healed femoral shaft fracture. A 32 year-old woman with a healed right femoral shaft fracture asked for ZMS intramedullary nail removal. When we attempted to extract the nail 8 years after insertion, incarceration of distal end at the healed fracture level was encountered. Forceful extraction of the nail caused fracture of the femoral shaft near the old fracture site. The specific design of ZMS First generation nail includes four flutes on the nail shaft for enhancement of fixation stability. However those flutes did not continue down the entire length of the nail, which makes the distal end relatively bulky. When the distal bulky end encountered the fracture site during nail extraction, the endosteal bone incarcerated into the flutes cause difficulty in nail extraction and possible femoral shaft fracture. Orthopaedic surgeons should be aware of the possibility of an incarcerated nail when attempt to remove this design of nail and should inform the patient for the possibility of this complication preoperatively.