Said G Z, Farouk O, Said H G Z
Department of Orthopaedic Surgery and Traumatology, Assiut University Hospitals, 71516 Assiut, Egypt.
Injury. 2005 Jul;36(7):871-4. doi: 10.1016/j.injury.2005.01.011. Epub 2005 Mar 31.
We report five cases of intertrochanteric fractures that needed open reduction after failed closed reduction techniques. In all cases the shaft fragment included the lesser trochanter, and there was a long spike on the head-neck fragment. This was evident clinically as the proximal shaft, pulled by the iliopsoas tendon, produced a swelling in front of the hip joint. Radiographically, the fracture was minimally comminuted. The anteroposterior view revealed upward riding of the shaft fragment, while lateral view showed the femoral shaft in front of the head and neck. We describe a three-step technique, which was applied for open reduction in these unusual cases. With the patient supine on a standard operating table, the fracture site was exposed. The limb was placed in full adduction and external rotation to slacken the iliopsoas tendon. A Hohmann retractor was then passed medial to the shaft and behind the fractured surface of the sunken femoral neck, levering it anteriorly. Traction in abduction and internal rotation was applied to complete the reduction. Additional iliopsoas tenotomy was performed in two patients. All cases were fixed with a dynamic hip screw and all fractures united uneventfully.
我们报告了5例股骨粗隆间骨折病例，这些病例在闭合复位技术失败后需要切开复位。所有病例中，骨干骨折块均包括小转子，头颈骨折块上有一个长骨尖。临床上，这表现为近端骨干受髂腰肌肌腱牵拉，在髋关节前方形成肿胀。影像学上，骨折为轻度粉碎性骨折。前后位片显示骨干骨折块向上移位，侧位片显示股骨干位于头颈前方。我们描述了一种三步技术，用于这些特殊病例的切开复位。患者仰卧于标准手术台上，暴露骨折部位。将肢体完全内收并外旋，以松弛髂腰肌肌腱。然后将一个霍曼牵开器置于骨干内侧并位于股骨颈凹陷骨折面后方，将其向前撬起。进行外展和内旋牵引以完成复位。两名患者还进行了额外的髂腰肌肌腱切断术。所有病例均用动力髋螺钉固定，所有骨折均顺利愈合。
