Introduction Proximal Femoral Nail Anti-rotation (PFNA) is a routine method to deal with intertrochanteric fractures in the elder population. It is extremely difficult to remove PFNA in some cases as a result of stripping of blade heads. In this Technical Note, we report a simple technique using commonly available instrument that can be used to remove stripped even broken anti-rotation blade where regular methods have failed.
Methods The subject underwent a PFNA removal surgery fifteen months after the previous fixation. We encountered difficulties using regular instrument to remove the anti-rotation blade. A 5mm tungsten carbide bur was used to drill a single cortical hole at the end of the blade. Then double-strand steel wire was threaded through the hole and the distal part was shaped into a circle which could tie to the extraction screw. Slide Hammer was applied to gently knocked out the blade along the anatomical direction of the femoral neck.
Results The technique helped us successfully remove the dispatched anti-rotation blade and provided the patient with a satisfactory result.
Conclusion The use of a tungsten reamer and steel wire loop to remove the proximal femoral anti-rotation blade may provide a simple and cost-effective method of dealing with extraction failure.