Preoperative planning and sequential technique for extraction of a broken cannulated bolt from a proximal femoral nail: A case report.

Intertrochanteric femur fractures (IT fractures) either stable or unstable type particularly in geriatric patients, are often managed using Proximal Femoral Nail (PFN). Yet, implant complications like fractured cannulated bolts, distal screws, or the nail still occur. These issues may result from technical errors, the wrong size of implant, or patient/implant-related factors. The extraction of a broken screw segment stuck deep within the femur head is always problematic. This paper reports an inexpensive and reproducible technique for the extraction of a fractured cannulated bolt of the PFN that is inserted in the head of the femur. A 65-year-old man underwent surgery with a stainless steel PFN eight months before, presented with left hip pain and a limp. There was varus malalignment, non-union, and a fractured 8 mm cannulated bolt on X-ray. Before surgery, three options were considered, and the team successfully used a 2.5 mm drill bit with a battery-powered drill to retrieve the broken part. The revision fixation was performed with an appropriately sized titanium PFN to restore alignment and stability. This straightforward and low-cost method allows safe removal of broken bolts, reduces extra bone damage, and works well even in hospitals with limited resources.