Technical tip: Hitch and compression conical tamp technique for intramedullary nail extraction

Extracting intramedullary nails presents significant challenges, especially when conventional nail extraction techniquesfail due to thread damage or implant compatibility issues. This technical report presents an innovative approach known as the "hitch-and-compression" conical tamping technique, which was applied to a 58-year-old patient who had received a retrograde tibial nail implanted in the hindfoot 14 years earlier to stabilise and fuse the tibio-talo-calcaneal joints. Due to the inability to engage the proximal nail threads, conventional methods were not possible during the procedure. The technique involves using a Steinmann pin to control rotation, a hooked extractor to grasp the distal anchor point, and conical tamping to stabilise the structure and transmit axial force effectively. Extracting the nail without causing any damage, especially unintended damage, was the real and primary challenge. Other key points are the absence of complications during the procedure, the stability of the extraction construct during nail extraction, and the duration of the procedure. This method's proven effectiveness lies in its absence of proximal intact sutures or specialised equipment, making it applicable to various clinical situations. The lack of post-operative follow-up and comparative data with other extraction methods are limitations of this promising technique. Although it offers a practical alternative solution for complex cases requiring intramedullary nail extraction, further research is needed to confirm its effectiveness on a more comprehensive scale.