ArticleAME case reports2026
Management of a bent tibial intramedullary nail following refracture: a case report and literature review.
Article in AME case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
Background: Tibial refracture combined with intramedullary nail (IMN) plastic deformation after initial internal fixation is a rare clinical complication. Its management involves removal of the bent IMN and reduction/fixation of the refracture. Currently, there is no unified standardized treatment protocol, and the technical operation is challenging. Further accumulation of case evidence is needed to optimize diagnostic and therapeutic strategies. Case Description: A 28-year-old male patient underwent tibial IMN internal fixation for a midshaft tibial fracture 2 years prior. On July 6, 2025, he was admitted to the hospital due to right leg swelling, pain, and limited mobility for 5 hours following a collision between his bicycle and a car. The diagnosis was right midshaft tibial refracture after internal fixation and right distal fibular fracture. Imaging examinations revealed plastic deformation of the tibial IMN, with 13° lateral curvature in the coronal plane and 19° anterior angulation in the sagittal plane. The treatment plan included: first, open reduction and plate internal fixation of the right fibular fracture to maintain limb length; second, direct removal of the bent IMN using an impactor; third, intramedullary canal reaming; and finally, closed reduction and internal fixation of the right tibial fracture with a lengthened IMN. X-ray re-examination 1 month postoperatively showed callus formation. The patient resumed normal weight-bearing ambulation 2 months postoperatively with good functional recovery. Conclusions: This case validates the rationality of the 20° critical angle for closed removal of bent IMNs proposed by Kose
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