1. Removal of a Broken Solid Femoral Nail: a Simple Push- out Technique. A Case Report* by CHRISTIAN KRETTEK, PETER SCHANDELMAIER, and HARALD TSCHERNE J Bone Joint Surg Am Volume 79(2):247-51 February 1, 1997 ©1997 by The Journal of Bone and Joint Surgery, Inc.

2. Fig. 1-A: Preoperative radiograph showing the infra-isthmal fracture of the femoral shaft. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

3. Fig. 1-B: Radiograph made after insertion of a solid titanium-alloy nail with static locking with screws. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

4. Fig. 1-C: Higher-magnification lateral radiograph of the end of the nail at nine weeks postoperatively, showing a complete crack through the nail at the more proximal of the two distal screw-holes. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

5. Figs. 2-A through 2-I: Schematic drawings illustrating the push-out technique for removal of the distal fragment of a solid femoral nail, which had broken at the level of the more proximal of the two distal screw-holes. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

6. Figs. 2-B and 2-C: Preparation of the so-called lateral working channel. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

7. Figs. 2-B and 2-C: Preparation of the so-called lateral working channel. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

8. Fig. 2-D: The working channel is enlarged in a proximal direction (arrows) with a curet. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

9. Fig. 2-E: A spike is inserted in the lateral aspect of the distal screw-hole, and the distal end of the broken nail is worked proximally. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

10. Fig. 2-F: A narrow Hohmann retractor is inserted in the working channel. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

11. Fig. 2-G: With gentle pressure on a nail that was inserted through the proximal part of the femur, the fragment is pushed out through the working channel. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

12. Figs. 2-H and 2-I: The bone cylinder is replaced, and renailing can be performed. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

13. Figs. 2-H and 2-I: The bone cylinder is replaced, and renailing can be performed. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.

14. Fig. 3 Radiographs made sixteen months after renailing, demonstrating healing of the corticocancellous bone cylinder and of the fracture. CHRISTIAN KRETTEK et al. J Bone Joint Surg Am 1997;79:247-51 ©1997 by The Journal of Bone and Joint Surgery, Inc.