Ahla Fatima Maqsood, Izhar-ul Haq, Unaiza Siddique, Muhammad Maqsood Ahmed.
Role of Cutting-out Technique in Removal of a Bent Kuntscher Nail Using Steel Cutting Blade at Periphery Healthcare.
Esculapio J Services Inst Med Sci Jan ;13(4):170-3.

Objective: To demonstrate the effectiveness of cutting-out nail technique using simple, cheap and readily available steel cutting blade to remove bent Kuntscher nail. Method: This study was carried out for a period of three years, from July 2014 to June 2017, in the department of orthopedic surgery at DHQ Hospital Vehari. Inclusion criteria were either gender of age between 15 to 60 years. All patients underwent removal of Kuntscher nail using the technique in which the nail was cut with the help of a simple metal cutting blade, and both fragments were removed from the fracture site. Ten cases were included in the study. The patients under went pre operative, general and systemic examination. The initial investigation comprised of baseline pre-operative investigation, skiagrams of the fractured bone. Osteosyntheses was done with the use of over sized nail or dynamic plate. Bone grafting was done to augment the union, in each case. Usually patients were discharged on fourth postoperative day. All patient were observed in post-operative period for detection of complications. Results:Atotal number of ten patients were included in this study. The mean age of all patients was 36+-6 years. Patients came from less educated background. 80% of the patients were male and 20% were female. In 20% patients' angulation was less than ten degree and nail was removed proximally. Among 50% patients over size nail was used and other 30% patients compression plate was used. All patients were made mobile with help of crutches. Early range of motion was started and the union at the fracture site was achieved after 3 to 4 months. According to Flynn Criteria outcome was excellent. Conclusion: The use of cut-and-remove technique for removal of bent Kuntscher nail is better option in peripheral hospitals, as it is a simple operating technique, which gives satisfactory outcome with minimum complication rates, lesser operating time and lesser expense to accomplish the goal of treatment. So it could be considered as a favorable treatment option where advanced gadgetries for transecting the nail may not be present.

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