## 3 Techniques for Distal Broken Tibial Nail Extraction
### The Fenestration Extraction Method
#### 3.6.4 Distal Tibial Cortical Windowing and Retrograde Punching Using a Tamp
\begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Figure** & **Technique** & **Advantages** & **Disadvantages** & **Availability** & **Nail Type** \\ \hline
6. & Adaptation 2—retrograde ball-tipped guide wire & \begin{tabular}{c} Provides a strong and secure grip on the broken nail, \\ allowing for precise removal. \\ Minimally invasive, \\ cheap, available. \\ \end{tabular} & \
\begin{tabular}{c} Designed for femoral \\ nails—only adaptations of it \\ can be used for tibia. \\ \end{tabular} & R.A. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
6. & **3.3. Hooks at the distal end of the nail** & \begin{tabular}{c} Provides direct access to the \\ broken nail. \\ \end{tabular} & \
\begin{tabular}{c} Limited to larger nails. Can \\ be costly. \\ \end{tabular} &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
7. & Dedicated extraction hook (commercially available) & Easy to use and more efficient. & Limited to larger nails. Can \\  & (commercially available) & \
\begin{tabular}{c} be costly. \\ \end{tabular} & C.A. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
8. & Modified AO technique using guidelines & \begin{tabular}{c} Allows for more control and \\ using a cortical screw to \\ deflect the hook \\ \end{tabular} & \
\begin{tabular}{c} Limited to larger nails. Can \\ be costly. \\ \end{tabular} & C.A. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
9. & \begin{tabular}{c} Modified AO technique \\ using a 2 mm flexible nail \\ introduced into distal slot \\ \end{tabular} & \begin{tabular}{c} Allows for better control and \\ precision during \\ nail extraction. \\ \end{tabular} & \
\begin{tabular}{c} Limited to larger nails. \\ technically more \\ demanding. Can be costly. \\ \end{tabular} & C.A. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
10. & \begin{tabular}{c} Self-made stainless steel \\ minimally invasive rail \\ extractor \\ \end{tabular} & \begin{tabular}{c} Allows for constant effective nail \\ extraction with minimal tissue \\ damage. \end{tabular} & \
\begin{tabular}{c} Limited to larger nails. May \\ not be as precise as \\ commercially \\ available options. \\ \end{tabular} & S.M. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
11. & \begin{tabular}{c} Self-made stainless steel \\ minimally invasive rail \\ extractor \\ \end{tabular} & \begin{tabular}{c} Allows for minimal invasive \\ extraction and better grip on \\ the nail. \\ \end{tabular} & \
\begin{tabular}{c} Limited to larger nails. May \\ not be as precise as \\ commercially available \\ options. Weakness in \\ holding power—can slip. \\ \end{tabular} & S.M. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
13. & \begin{tabular}{c} Kirschner wire \\ angled hook \\ \end{tabular} & \begin{tabular}{c} Cheap. Allows for minimal \\ invasive extraction and better \\ giving on the nail. \\ \end{tabular} & \
\begin{tabular}{c} Limited to larger nails. Lack \\ of availability of a \\ long K-wire. \\ \end{tabular} & R.A. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
14. & \begin{tabular}{c} Retrograde Kirschner wire \\ angled hook \\ \end{tabular} & \begin{tabular}{c} Cheap, allows for minimal \\ invasive extraction and better \\ grip on the nail. \\ \end{tabular} & \
\begin{tabular}{c} Limited to larger nails. Not \\ always reproducible. \\ \end{tabular} & R.A. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
15. & \
\begin{tabular}{c} **3.4. Closed cerclarge wire** \\ **pull-out technique for** \\ **solid non- cannulated** \\ **nail implants** \\ \end{tabular} & Minimally invasive. &
\begin{tabular}{c} May be difficult to achieve \\ proper positioning of the \\ instruments. Necessitates \\ extensive earning. \\ \end{tabular} & S.M. & Solid \\ \hline
16. & \begin{tabular}{c} **3.5. Laparoscopic** \\ **grasping forceps** \\ \end{tabular} & Minimally invasive & \
\begin{tabular}{c} May be difficult to achieve \\ proper positioning \\ of the instruments. \\ \end{tabular} & C.A. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
17. & \begin{tabular}{c} Retrograde 3 mm \\ ball-tipped guide wire \\ through the opening in the \\ medial malleolus \\ \end{tabular} & Low complication rate. & \
\begin{tabular}{c} Technically difficult and the \\ degree of irradiation may \\ be higher. \\ \end{tabular} & R.A. &
\begin{tabular}{c} Hallow/ \\ cannulated \\ \end{tabular} \\ \hline
18. & \begin{tabular}{c} Tibial cortical windowing \\ and retrograde levering \\ \end{tabular} & Provides direct access to the \\ and retrograde levering & \begin{tabular}{c} Produces direct access to the \\ broken nail. \\ \end{tabular} & \
\begin{tabular}{c} Technically demanding. \\ Needs skill. Risk of damaging \\ surrounding structures. \\ \end{tabular} & R.A. &
\begin{tabular}{c} Solid \\ shallow/ \\ cannulated \\ \end{tabular} \\ \hline \hline \end{tabular}
\end{table}