# Traumatic In-Situ Fracture of an Etonogestrel Implant (Nexplanon®) Presenting as Altered Palpation Without Bleeding: A Case Report and Review of Literature

## TL;DR

A woman's contraceptive implant broke after a fall, causing no bleeding but altered touch, and was successfully removed in two pieces.

## Contribution

This case highlights a rare traumatic fracture of an in-situ etonogestrel implant presenting without bleeding.

## Key findings

- Implant fracture presented as altered palpation without bleeding.
- Two fragments were successfully removed via small incisions.
- No complications occurred post-removal.

## Abstract

Etonogestrel implant fracture is rare with uncertain clinical impact. We report a traumatic in-situ fracture to highlight evaluation and management. A 27-year-old gravida 3 para 3 (G3P3) presented three months after a fall, noting her upper-arm implant felt “broken.” During examination, palpation demonstrated loss of rod continuity with proximal and distal fragments. She had no abnormal bleeding from the uterus or the implant site. After counseling about uncertain effects on hormone release and efficacy, removal was performed under local anesthesia via two ~5-mm incisions. Two fragments (2.6 cm and 1.4 cm) were retrieved intact, and recovery was uncomplicated. She declined immediate replacement. Traumatic implant fracture may present solely as altered palpation. Clinicians should assess integrity after arm trauma, use imaging if nonpalpable, confirm complete removal, and offer immediate replacement of contraception.