Bending the Limits: Modified F-Tool E-Joystick System for Controlled Realignment of a Bent Femoral Nail: A Technical Report

Background: Intramedullary nailing is the standard treatment for femoral shaft fractures, but mechanical implant failure—particularly bent-nail deformity—is rare and poses significant technical challenges during extraction. Conventional removal methods may be ineffective or risky, necessitating innovative strategies for controlled deformity correction and safe revision. Materials and Methods: A 35-year-old male presented with pain and deformity in a previously nailed femur following a fall, 2 months postoperatively. Imaging revealed nail bending, cerclage wire failure, and refracture. Initial attempts at closed and instrument-assisted manipulation were unsuccessful due to dense medial callus and cortical collapse at the bend apex. A novel modified reduction F-tool, E-Joystick, using a 3-point lever-pivot-counterforce configuration with an adjustable bend was developed intraoperatively to enable controlled distraction osteoclasis and realignment under fluoroscopy, followed by exchange nailing. Results: Deformity correction and safe nail extraction were successfully achieved, and a larger-diameter intramedullary nail was implanted. Structured rehabilitation with staged loading resulted in radiographic union, full hip and knee motion, no limb-length discrepancy, and pain-free ambulation at long-term follow-up. Discussion: The modified E-Joystick technique provides a controlled, minimally disruptive alternative when conventional extraction of bent nails fails, potentially expanding surgical options for early implant failure in complex femoral nonunion cases.