Intramedullary breakage of the orthopedic instrument is an uncommon event among orthopedic surgeons. Although very little literature is available on this subject, every surgeon must be familiar with the problem and the different ways to tackle it. We report a simple cost-effective innovative technique to remove an intramedullary broken drill bit.
A 35-year-old man presented to our outpatient department with pain and deformity of the right forearm for 3 months. He sustained road traffic accident 3 months back and had closed injury to his right forearm. He underwent indigenous treatment in the form of native splints and oil massage for 2 months. On examination, he had tenderness and his forearm rotations were grossly restricted. Plain radiographs revealed an ununited fracture of both bones forearm.
Patient was planned for open reduction and internal fixation of both bones forearm. The ulna was exposed through the standard approach and the fracture site was exposed. The fracture ends were freshened and we tried to open the medullary canal with a small bone awl. As the awl was not able to enter the medullary cavity, we used a 2.5-mm noncannulated drill bit to open the medullary canal of the proximal fragment. Unfortunately, the drill bit broke and the distal end of the drill bit was inside the medullary cavity of the ulna. We tried to retrieve the broken drill bit by the following technique.
An image was taken using image intensifier to locate the drill bit (Fig. 1). A 4-mm drill bit was used to just enlarge the medullary cavity just at the entry site. A long-depth gauge from the 4.5 mm system was passed into the medullary canal on the inner aspect of the opposite cortex so that the tip of the depth gauge crosses the broken drill bit piece (Fig. 2). Then under image intensifier the hook of the depth gauge was positioned at the proximal tip of the broken drill bit and the depth gauge was pulled with adequate force. The broken drill bit was retrieved (Figs. 3, 4). We then reduced both radius and ulna and stabilized with small fragment dynamic compression plate.
The orthopedic instrument breakage rate ranges between 0.18% and 0.35%.1,2 The actual incidence rate might be higher but this complication is underreported. Drill bit is the most common instrument which is prone to breakage probably because of its increased incidence of reusage. Application of excess bending moment overwhelms the bending strength and results in failure of drill bit. Most of the times, attempts are not made to remove the broken drill bit in the medullary canal as it is cumbersome and time-consuming. Sometimes specialized instruments might be required. Very few studies have been reported regarding techniques to retrieve a broken drill bit.
Bassi et al3 described a technique for removal of broken cannulated drill bit. They passed multiple K wires through the cannulated drill bit and retrieved it. Mounasamy et al4 reported a technique to remove broken drill bit from femoral medullary canal. They inserted a pituitary rongeur through the fracture site and retrieved the drill bit.
We have used a depth gauge in the 4.5 mm system which is readily available in all-plating instrumentation. The tip of the depth gauge used in 3.5 mm system is very small and is not sufficient to hold the proximal tip of the drill bit. However, the tip of 4.5 mm system depth gauge is like a hook and is also large enough to retrieve the drill bit.
The advantages of this technique are its simple, cost-effective, and less time-consuming. The main disadvantage of this technique is the need for an image intensifier intraoperatively. Although the success rate with this technique is questionable, as we have attempted only in 1 case, it is definitely a simple useful trick. However, this technique will not be possible in other long bones where the medullary canal is wide.
To conclude, depth gauge can be tried as a tool to retrieve the broken intramedullary noncannulated drill bit.
1. Price MV, Molloy S, Sollan MC, et al. The rate of instrument breakage during orthopaedic procedures. Int Orthop. 2002;26:185–187.
2. Pichler W, Mazzurana P, Clement H, et al. Frequency of instrument breakage during orthopedic procedures and its effect on patients. J Bone Joint Surg Am. 2008;90:2652–2654.
3. Bassi JL, Pankaj M, Navdeep S, et al. A technique of removal of a broken drill bit: Bassi’s method. J Orthop Trauma. 2008;22:56–58.
4. Mounasamy V, Desai P, Mallu S, et al. A novel method of removal of a broken drill bit in the femoral medullary canal during internal fixation of a type C distal femoral fracture: a case report. Chin J Traumatol. 2012;15:315–316.