Removal of Distally Migrated Cannulated Interlocking Tibial Nail Using Schanz Screw

SUMMARY
Background: Distal migration of nails is one of the reasons for nails removal, though they are hardly reported in relation to cannulated interlocking nails.
Objectives: To present a rare case of distally migrated cannulated interlocking nail of the tibia and a proposed technique for the removal of the nail using Schanz screw.
Case: A 55year old woman had cannulated interlocking nailing for diaphyseal left tibial fracture 5 years prior to presentation. She later had septic loosening of the distal locking screw with subsequent symptomatic distal migration of the nail despite united osteosynthesis. Attempt at free hand removal using conventional instruments failed due to increased distance of the nail from the entry point, malrotation and lack of visibility of the nail following obliteration by fibrous and granulation tissues within the nail cavity. Thus, an improvisation with Schanz screw, due to its threading surface was used to capture and remove the nail successfully without any cortical damage of the bone.
Conclusion: The use of Schanz screw is a safe, cheap and effective means of free hand removal of distally migrated cannulated interlocking nails.