{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:10:01Z","timestamp":1756311001273,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,3,18]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>The Kuntscher nail (K-nail) was initially designed with an axial section in the letter \u2018V\u2019 shape. Still, it was later reintroduced in a cloverleaf shape to achieve additional strength and easier use. Migration of the K-nail proximally or distally in the femur is a well-documented complication, with distal migration reported as one of the complications in the 1940s. However, spontaneous extrusion of the K-nail proximally is a rare complication. The common causes of the extrusion include disuse\/senile osteoporosis, infection, inappropriate K-nail size, delayed union with shortening and premature weight bearing.<\/jats:p>\n               <jats:p>A woman in her early 80s presented with a history of a fall 3\u2009months ago. She had pain in the left hip and was unable to bear weight. She was diagnosed with a left neck of femur fracture. On the right side, she had a femur shaft fracture for which K-nailing was done 11 years ago. She started feeling the implant in her right buttock for 3 years but did not seek medical advice and was able to do her routine activities. She underwent implant removal on the right side with left hip hemiarthroplasty.<\/jats:p>\n               <jats:p>Spontaneous migration of the K-nail proximally is an uncommon presentation. It is suggested that K-nails be routinely removed as soon as union and consolidation of the fracture are achieved radiologically.<\/jats:p>","DOI":"10.1136\/bcr-2024-264673","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T09:55:15Z","timestamp":1743846915000},"page":"e264673","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous proximal migration of Kuntscher nail: an uncommon complication"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4583-2508","authenticated-orcid":false,"given":"Sharan","family":"Mallya","sequence":"first","affiliation":[{"name":"Orthopaedics, AIIMS Guwahati, Guwahati, Assam, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gumin","family":"Tayeng","sequence":"additional","affiliation":[{"name":"Orthopaedics, AIIMS Guwahati, Guwahati, Assam, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashok","family":"Puranik","sequence":"additional","affiliation":[{"name":"Orthopaedics, AIIMS Guwahati, Guwahati, Assam, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajdeep","family":"Das","sequence":"additional","affiliation":[{"name":"Orthopaedics, AIIMS Guwahati, Guwahati, Assam, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,5]]},"reference":[{"key":"2025082708493298000_18.4.e264673.1","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/S0030-5898(20)31463-2","article-title":"Comminuted fractures of the femoral shaft treated by intramedullary nailing","volume":"11","author":"Winquist","year":"1980","journal-title":"Orthop Clin North Am"},{"key":"2025082708493298000_18.4.e264673.2","doi-asserted-by":"crossref","first-page":"208","DOI":"10.2106\/00004623-197456010-00027","article-title":"Fischer S: Gerhard Kuntscher 1900-1972","volume":"56","author":"Fischer","year":"1974","journal-title":"J Bone Joint Surg Am"},{"key":"2025082708493298000_18.4.e264673.3","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1302\/0301-620X.32B4.694","article-title":"Medullary nailing of fractures after fifty years; with a review of the difficulties and complications of the operation","volume":"32-B","author":"Watson-Jones","year":"1950","journal-title":"J Bone Joint Surg Br"},{"key":"2025082708493298000_18.4.e264673.4","doi-asserted-by":"crossref","first-page":"670","DOI":"10.2106\/00004623-195133030-00013","article-title":"Results in medullary nailing of ninety-five fresh fractures of the femur","volume":"33-A","author":"Bohler","year":"1951","journal-title":"J Bone Joint Surg Am"},{"key":"2025082708493298000_18.4.e264673.5","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1951.01250040689016"},{"key":"2025082708493298000_18.4.e264673.6","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.2106\/00004623-196345080-00006","article-title":"THE MANAGEMENT OF SEPSIS FOLLOWING INTRAMEDULLARY FIXATION FOR FRACTURES OF THE FEMUR","volume":"45","author":"Macausland","year":"1963","journal-title":"J Bone Joint Surg Am"},{"key":"2025082708493298000_18.4.e264673.7","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1445-2197.1963.tb03300.x","article-title":"FRACTURED FEMORAL SHAFTS. A REVIEW OF 127 CONSECUTIVE CASES INCLUDING 53 TREATED BY KUNTSCHER NAIL FIXATION","volume":"33","author":"O\u2019brien","year":"1963","journal-title":"Aust N Z J Surg"},{"key":"2025082708493298000_18.4.e264673.8","unstructured":"Kuntscher G . Die Marknagelung von Knochenbruchen. Arch Klin Chir 1940;443\u201355."},{"key":"2025082708493298000_18.4.e264673.9","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2106\/00004623-195840010-00002","article-title":"The Kuntscher method of intramedullary fixation","volume":"40-A","author":"Kuntscher","year":"1958","journal-title":"J Bone Joint Surg Am"},{"key":"2025082708493298000_18.4.e264673.10","unstructured":"Kuntscher G . The Marrow Nailing Method. Germany: U.S. Fleet, U.S: Naval Forces: Technical Section (Medical), 1947."},{"key":"2025082708493298000_18.4.e264673.11","first-page":"182","article-title":"Primary reamed intramedullary nailing of open femoral shaft fractures","volume":"PMID","author":"Williams","year":"1995","journal-title":"Clin Orthop Relat Res"},{"key":"2025082708493298000_18.4.e264673.12","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S0020-1383(05)80002-6","article-title":"Treatment of fracture of the shaft of the femur in total hip arthroplasty by a combination of a K\u00fcntscher nail and a modified cemented Charnley stem","volume":"23","author":"Wroblewski","year":"1992","journal-title":"Injury"},{"key":"2025082708493298000_18.4.e264673.13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4103\/1116-5898.149604","article-title":"Spontaneous extrusion of a distally migrated K\u00fcntscher intramedullary nail from the left femur through a sinus over the knee joint","volume":"24","author":"Ihegihu","year":"2014","journal-title":"Niger J Surg Sci"},{"key":"2025082708493298000_18.4.e264673.14","first-page":"10","article-title":"A Technical Note for Extracting an Incarcerated Femoral Kuntscher Nail","volume":"6","author":"Mar\u00ed","year":"2016","journal-title":"J Orthop Case Rep"},{"key":"2025082708493298000_18.4.e264673.15","article-title":"Spontaneous Distal Migration and Protrusion of a K\u00fcntscher Intramedullary Nail from the Left Femur: A Rare Complication","volume":"12","author":"Jain","year":"2020","journal-title":"Cureus"},{"key":"2025082708493298000_18.4.e264673.16","article-title":"Spontaneous Distal Extrusion of Kuntscher Intramedullary Nail","volume":"2021","author":"Teh","year":"2021","journal-title":"Case Rep Orthop"},{"key":"2025082708493298000_18.4.e264673.17","doi-asserted-by":"crossref","first-page":"110","DOI":"10.18231\/j.ijos.2023.023","article-title":"Spontaneous distal migration of Kuntscher intramedullary nail into leg from malunited distal femur fracture: A rare case report","volume":"9","year":"2023","journal-title":"IJOS"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264673","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:49:43Z","timestamp":1756309783000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264673"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,5]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bcr-2024-264673"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264673","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}