Dr Abhijit Tayade et al JMSCR Volume 03 Issue 09 September Page 7666 JMSCR Vol||3||Issue||9||Page 7666-7669||September 2015 Bent and Incarcerated Vnail in A Distal 1/3 rd Tibia and Fibula Fracture: A Rare Case Report Authors Dr Abhijit Tayade, Dr Sachin Kale, Dr Sanjay Dhar, Dr Abhay Agarwal, Dr Naba Krishna Gohain Dept of Orthopaedics, DY Patil School of Medicine, Navi Mumbai Introduction Intramedullary nailing is the gold standard technique for treatment of tibial shaft fractures. Bending of a nail secondary to high velocity trauma is a complication, encountered in healed or unhealed tibial shaft fractures. Removal of such a nail is always a challenge as the bent nail needs to be removed because it might take the shape of the nail; which is likely to become weaker and weaker as a result of the angulation and may break in future. Removal should be done as early as possible. We report this case of bent nail removal in a 47-year-old man, admitted in our hospital who sustained a fracture of the left distal 1/3 rd tibia and fibula with V nail in situ due to a roadside accident. A 47yr old male patient presented to us with pain and deformity in left leg after an alleged history of road traffic accident. Patient was a post operated case of left distal 1/3 rd tibia and fibula fracture operated with closed reduction and internal fixation with v nail 10 years ago. patient had recovered completely post operative at that time and was given above knee cast for 3 months and then started weight bearing after 3 months as advised my his previous surgeon. Physical examination revealed deformity at distal 1/3 rd leg, skin condition were normal , no sign of distal neuro vascular deficit and there was no abnormal mobility at fracture site (FIG-1).Range of motion at knee could not be elicited due to pain and at ankle was pain full .patient was immediately immobilised in above knee slab . After getting Fresh x-rays of left tibia full length in both ap and lateral planes which showed-distal 1/3 rd tibia and fibula fracture with Vnail in situ with 35 degree posterior and 60 degree valgus angulations and extensively impacted within the bone(FIG-2).patient was posted for surgery once fit. Attempt was made to remove the nail by standard technique, as described by Patterson and Ramser12 for bent nail which failed. We did reduction of deformity (FIG-3) and tried v nail removal by standard method, by universal extractor but due to extensive impaction within the bone the extraction eye broke in situ (FIG-4) and therefore Anterior linear cortical osteotomy of entire tibia was done (Fig-5). During the osteotomy a plane was created between the bone and the vnail in the proximal fragment as there was impaction in the posterior lateral cortex for www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x DOI: http://dx.doi.org/10.18535/jmscr/v3i9.62