The first description in the literature, of a complication during the extraction of a retrograde expandable intra-medullary nail in three patients

Ankle fractures in elderly people are low-energy fractures characterised by fragility. In the majority, they are unstable and challenging to manage. Retrograde expandable intra-medullary nails (Fixion®, Biomet Merck Limited) inserted through the calcaneum across the sub-talar and ankle joints into the tibia have been successfully used in the treatment of fragility fractures and non-unions of the distal tibia and ankle, where the use of an antegrade locked nail would not provide adequate fracture stability for union. Primary fracture management involves removing the nail at least 3–4 months after radiological check. In cases of treatment of non-unions a longer treatment period is often required before removal of nail is considered. We present three patients where breakage of the Fixion® nail during surgery caused problems in nail extraction.