Faraj A A, Johnson V G
Orthopaedic Department, Hull Royal Infirmary, Analby Road, Hull, United Kingdom.
Acta Orthop Belg. 2002 Apr;68(2):178-81.
Technical errors during intramedullary nail insertion are not uncommon. We report a case of tibial guide wire penetration into the distal tibial articular surface, the talus and the calcaneus during insertion of the nail with the ankle dorsiflexed. This has not been reported in the past. Computerized tomogram was a useful tool in the diagnosis. This complication was associated with long-standing ankle pain, which however eventually settled. We advise frequent use of biplanar C-arm image during the insertion of the guide wire, the reamer and tibial nail into the medullary canal of the tibia or other long bones. None of these instruments should be forced through. Once the knobbed guide wire is exchanged to a straight guide wire, the wire should not be forced through or reamed over, and the nail should be introduced over the guide wire with caution. Early intraoperative identification and recording of this iatrogenic accident is necessary in order to explain the situation to the patient and modify treatment accordingly.
髓内钉插入过程中的技术失误并不罕见。我们报告一例在踝关节背屈时插入髓内钉过程中胫骨导丝穿透胫骨远端关节面、距骨和跟骨的病例。过去尚未有过此类报道。计算机断层扫描是诊断中的有用工具。这种并发症与长期踝关节疼痛相关，但最终疼痛缓解。我们建议在将导丝、扩孔钻和胫骨钉插入胫骨或其他长骨髓腔时，频繁使用双平面C型臂影像。这些器械均不应强行通过。一旦将带旋钮导丝更换为直导丝，不应强行通过导丝或进行扩孔，且应谨慎地将髓内钉沿导丝插入。术中早期识别并记录这一医源性事故，以便向患者解释情况并相应调整治疗方案。
