# Revisiting the Vertical Osteotomy Technique for the Removal of a 20-Year-Old Tibial Intramedullary V-Nail: A Case Report

## TL;DR

This case report describes a vertical osteotomy technique used to remove a 20-year-old tibial intramedullary V-nail that had become difficult to extract.

## Contribution

The paper presents a specific vertical osteotomy technique for long-term implant removal, addressing challenges from bone growth around the implant.

## Key findings

- Vertical osteotomy was successfully used to remove a long-term retained intramedullary V-nail.
- The technique helps overcome complications caused by new bone formation around the implant.
- The procedure can be considered when standard removal methods are not feasible.

## Abstract

Vertical osteotomy is a procedure occasionally used for the removal of intramedullary nails when the nail has become jammed, either due to expansion after initial fixation or the formation of a new bone around the nail. Implant removal of any type is usually performed when it is either recommended by the doctor or in response to the complaints of the patients, like sensations of pain, disorder, and infection associated with the potential complications of the given implant. There are different types of cases, which range from a simple procedure of K-wire removal or more complex procedures like intramedullary nail or plate removal. During the removal of implants, certain unforeseen complications can occur such as excessive bleeding, neurovascular deficit, and some other issues related to implants like breakage of screws or implants while removing it, which might lead to its inability to be removed. We present here a technique of vertical osteotomy that was used for the removal of implants in cases of long-term implant retention, which leads to difficulty in removing it.