Search

Breakage of tibial interlocking nails is a rare complication and is associated with tibial nonunion. The distal part of a broken tibial nail is difficult to extract and can be a real challenge. Preoperative planning is important, as the retrieval techniques of broken implants are not routine operations. There are various techniques and instruments described by different authors with none being uniformly successful. Therefore, surgeons should know as many methods as possible to choose the most suitable one. Minimally invasive retrieval techniques should be favored because of their reduced morbidity, while fenestration extraction methods should be used as the second intention. Cannulated intramedullary nails are more prone to benefitting from minimally invasive retrieval techniques than solid ones. This paper reviews and describes the present techniques used to extract the distal part of broken tibial nails, to serve as a quick guide for surgeons who need it.

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. “Masterly neglect” is a valuable option in selected cases.