The Removal of an Incarcerated Kuntscher Nail in a Patient Presenting With Femoral Neck Fracture: A Technical Case Report

The Kuntscher nail, once a pioneering solution for femoral shaft fracture fixation, has largely fallen out of use with the emergence of modern interlocking intramedullary systems. However, retained Kuntscher nails may still be encountered in older patients and can pose significant technical challenges when removal is required, especially in cases of incarceration. Standard closed extraction methods are often ineffective, necessitating alternative surgical strategies. This case report describes a novel and practical technique for the successful extraction of an incarcerated Kuntscher nail in a patient requiring hip arthroplasty following a femoral neck fracture. A 68-year-old male presented with a left femoral neck fracture after a fall. Imaging revealed a retained Kuntscher nail from a femoral shaft fracture treated 32 years earlier. Initial attempts at closed nail extraction through a trochanteric incision using standard tools were unsuccessful due to nail incarceration. A transverse femoral osteotomy was subsequently performed at the level of the nail shaft, and the nail was transected using a high-speed pneumatic drill. The distal nail segment was removed through the osteotomy site, while the proximal segment was extracted via the original incision. The procedure was completed with a hemiarthroplasty and open reduction internal fixation (ORIF) of the osteotomy. The patient had an uneventful postoperative recovery, with satisfactory osteotomy healing and preserved hip function at the one-year follow-up. Incarcerated Kuntscher nails often resist removal through conventional closed extraction techniques. Surgeons should be prepared to employ alternative strategies when standard methods fail. This case report presents a novel and practical technique for the successful extraction of a retained Kuntscher nail, offering a valuable option in such challenging scenarios.