abstractFull article available online at OrthoSuperSite.com/view.asp?rID=36004Removal of intramedullary nails is considered a routine procedure but may prove to be challenging. Bone ongrowth or overgrowth, damage to the proximal threads of the nail, and broken nails or locking screws may complicate intramedullary nail removal. This article presents a case of a 28-year-old patient with an incarcerated tibial nail and describes a salvage procedure for tibia nail extraction after all previously described methods have failed. The authors recommend that no excessive force be used to extract an incarcerated nail but to approach the problem in a step-wise fashion. If the nail is still incarcerated and will not move, the tibia needs to be completely open by removing a one-third of circumference longitudinal bone window. It is important to discuss all the possible options with the patient during the consent. The patient may not be aware of the difficulties that can be encountered during nail removal and the fact that it may necessitate a major procedure followed by a prolonged recovery time. It is important to ascertain the reason for nail removal and whether it is necessary to implement even drastic measures to do so. Infection, nonunion, deformity or refracture requiring fixation are indications for nail removal.