Procedure: Removal of left femur gamma nail.  Indication:  The patient presented with resolved left femur fracture, previously treated with gamma nailing, and now experiencing symptomatic hardware prominence with pain and soft tissue irritation.  The patient desired removal of the implant.  Risks and benefits of the procedure, including infection, bleeding, fracture, nerve injury, and the possibility of requiring additional surgery, were discussed and the patient provided informed consent.  Anesthesia:  General anesthesia was administered.  Surgical technique:  A sterile field was established.  A longitudinal incision was made over the previous surgical scar along the lateral aspect of the left thigh.  The gamma nail entry point and distal locking screws were identified and removed.  The gamma nail was then carefully extracted.  Hemostasis was achieved.  The incision was closed in layers using absorbable sutures.  A sterile dressing was applied.  Postoperative course:  The patient tolerated the procedure well and was transferred to the recovery area in stable condition.  Postoperative radiographs confirmed complete removal of the hardware.  The patient was instructed on postoperative care, including wound management, pain control with ibuprofen and acetaminophen, and activity limitations.  Follow-up appointment was scheduled for two weeks to monitor healing and address any potential complications.  Diagnosis:  Status post left femur fracture, retained orthopedic hardware, hardware prominence.  CPT codes considered:  27245, 20680.  ICD-10-CM codes considered:  M84.57XA, T84.010A, Z47.89.  This operative report dictates findings and procedures performed and is intended for use in a medical record.  This documentation does not constitute an order for future treatment.