A Novel Closed Method to Retrieve Broken Teflon Tube During Intramedullary Nailing in Proximal Humeral Fracture

Broken medullary tubes have been used for intramedullary (IM) nailing of femoral and tibial fractures. In these reported cases, fragments of the medullary tube were retrieved by opening the fracture sites or left in situ, which might jeopardize periosteal blood supply. We herein present the case of a 58-year-old woman who underwent IM nailing for proximal humeral fracture, which was complicated by breakage of the medullary tube intraoperatively. Different instruments including guide rods, straight forceps, and cement extract hook were used to retrieve the retained fragments from the medullary canal, but these attempts were unsuccessful. Finally, the fragments were successfully removed using an anterior cruciate ligament (ACL) ENDOBUTTON depth gauge. This case highlights that medullary tubes can break during humeral IM nailing, which could be minimized by ensuring integrity of the medullary tube prior to surgery and disposing medullary tubes with more than 100 exposures. A novel method of using ACL ENDOBUTTON depth gauge to retrieve retained tube fragments is recommended because of its long and slim design. 曾有報告描述於股骨和脛骨骨折在手術進行髓腔內釘程序時，膠導管有斷裂的情況，可用打開骨折的部位來移除或讓膠導管遺留於骨髓腔內。我們的個案是在肱骨近端骨折手術在進行骨髓腔內固定時，髓腔膠導管發生裂斷的情況。我們嘗試用了不同的儀器去移除殘留於髓腔內的膠導管，最後成功使用前交义韌帶深探針（ACL ENDOBUTTON depth gauge) 把兩段裂斷的膠導管取出。這個案例突顯出手術前若能先詳細檢查髓腔內膠導管是否完好及避免使用超過100次的膠導管，便能有效地減少此類手術的併發症。若手術時發生了膠導管斷裂的情況，可先嘗試使用不同的儀器包括前交叉韌帶深探針將遺留的膠導管取出，或打開骨折部位來移除，或最後不移除斷管也可考慮。