Reverse cutting guidewire for intramedullary nailing: a solution for a common yet undocumented and unresolved complication.

In 6 of the 81 patients who were treated with intramedullary nailing for a femoral or tibial fracture the ball-tipped guidewire was impossible to remove manually after nail implantation. In four cases we had to remove the implant and to re-insert the nail. While this is a relatively common complication well known to orthopaedic and trauma surgeons, it has not been previously reported. We developed and tested in vitro a reverse cutting guidewire that was able to successfully deal with this problem obviating the need for implant removal and re-insertion.