Retrieval of entrapped intramedullary fragments using laparoscopic instruments for fixation of femur and tibia fractures.

Cortical fragments within the intramedullary canal can pose a challenge during intramedullary nail treatment of tibial and femoral shaft fractures. Complications including reamer entrapment, malunion, and inability to pass final implants have all been reported. To limit soft tissue injury and avoid an open approach, laparoscopic instrumentation can be a useful adjunct to manipulate or retrieve cortical fragments at distant sites. Our objective is to outline a method to remove cortical fragments during treatment of tibial and femoral shaft fracture and characterize the standard shaft lengths diameters, tip configurations and jaw opening widths for common laparoscopic instruments.