Technique for removing a “cold-welded” interlocking screw from an intramedullary nail in the femur: A case report

Rationale: Removing a bent or broken intramedullary (IM) nail can be challenging even if the nail is intact. Several methods have been described for removing bent or broken nails. However, few studies have reported the removal of an IM nail when a proximal interlocking screw is cold-welded. We hope to share our successful treatment strategy for future use. Patient concerns: A 33-year-old male was admitted to our clinic for IM nail removal. The patient complained of discomfort in his right thigh when the weather changed. He had fallen down the stairs 3 years prior, causing a closed fracture of the right femur, and was treated with an IM nail. Diagnoses: Radiography showed an IM nail in the right femur. Interventions: Initially, the distal interlocking screw was easily removed using a screwdriver. Attempts to remove the proximal interlocking screw using various methods were futile. Finally, a high-speed cutting burr was used to cut the proximal interlocking screw. Outcomes: The IM nail was successfully removed. Lessons: A cold-welded proximal interlocking screw was encountered during IM nail removal. The applied technique is an effective alternative when a screw is difficult to remove using conventional tools.