## 1 Introduction  
Fractures of the tibial shaft are the most frequently occurring type of long bone fractures [1]. Intradedullary (IM) nailing has become the preferred method of treatment for most long bone fractures [2] because of biological and biomechanical advantages [3, 4]. Complications may occur, such as delayed union, nonunion, migration of hardware, or breakage of the tibial nail or screws [5].  
Open or multi-communited fractures are more frequently related to nonunion, delayed union, and risk of nail breakage [6]. Fatigue failure of the nail (fracture) due to over-stress (cyclical loading and stress accumulation at the fracture level or locking holes) is a possible scenario in a nonunion or delayed union [7]. Nonunion can be associated with residual pain and limitations in function [2], and usually necessitates reoperation (12-60% of cases) [8, 9].  
Treatment of an aseptic tibia noununion, with or without nail failure, requires closed exchange nailing. Intramedullary reaming is biologically important and has to be performed after (broken) nail removal, while re-osteosynthesis with a larger (1-4 mm) diameter nail offers mechanical advantages [10]. Closed exchange nailing is now one of the most accepted and popular methods to address tibia noununion.  
Closed replacement of a broken nail, which involves removing of the broken end of the nail, may be a challenging operation [11]. Typically, the proximal portion of a broken nail can be removed without much difficulty. The most difficult part is the extraction of the distal part. Multiple techniques have been developed for this purpose, but there is no standard procedure. All procedures have limitations regarding the success rate and failure to extract the broken part is not uncommon [11].  
Several specialized techniques to remove broken intramedullary tibial nails, as well as tips and tricks, have been described in the literature [12, 13, 14, 15, 16, 17, 18, 19, 20, 21].  
It is important for the surgeon to be familiar with a range of extraction methods and have the necessary equipment readily to ensure a successful outcome [7]. Unfortunately, these tools and pieces of equipment may not always be readily available. Some of them are commercialized by industry, others can be self-manufactured. Most described surgical techniques for removing nails in a retrograde manner involve the use of hooks, olive wires, or self-manufactured (improvised) instruments [11]. This paper reviews various methods for extracting a broken tibial nail and is describing some tips and tricks that can save the day. There is a wide variety of methods and instruments available, and it is crucial that surgeons have the knowledge and skills to choose the most appropriate method for their specific situation when removing broken distal nail components. In this article, we aim to provide a review of the different methods and instruments available, their indications, and their limitations. We acknowledge the importance of the surgeon's expertise and previous experience in selecting the right method for the right case. We hope this information will help surgeons make informed decisions when removing broken distal nail components.  
This review is unique in its examination of the extraction of a broken interlocking tibial nail. We highlight the importance of surgeons being familiar with a range of extraction techniques and having access to the necessary equipment, despite some of these tools and equipment potentially being difficult to obtain or requiring self-manufacture. We present a review of various methods for extracting a broken tibial nail, including practical advice for addressing challenging cases. Our review includes the most used techniques for extracting a broken tibial nail, as well as improvised methods that can be employed in situations where commercialized equipment is not available.