Wiltfong Roger E, Taylor Benjamin C, Steensen Robert N
Department of Orthopedic Surgery, Mount Carmel Medical Center, Columbus, Ohio, USA.
Orthopedics. 2011 May 18;34(5):395. doi: 10.3928/01477447-20110317-27.
This article presents a case of a 90-year-old woman who previously underwent a common femoral to anterior tibial artery bypass grafting with a Gore-Tex graft (Gore Medical, Flagstaff, Arizona). She subsequently sustained an ipsilateral intertrochanteric hip fracture after a mechanical fall and underwent internal fixation with an intramedullary nail using a fracture table. In the immediate postoperative period, she developed limb-threatening ischemia in her leg due to graft thrombosis. The patient underwent a successful thrombectomy and embolectomy. However, she subsequently developed nonhealing ulcers to this extremity over the course of weeks, requiring surgical debridement. Gangrene ensued and she underwent a below-the-knee amputation.Complications from the use of fracture tables have been described for perineal soft tissue injury, leg malrotation or malalignment, neurologic injury, and iatrogenic compartment syndrome of the healthy leg. Arterial complications after intramedullary fixation of femur fractures are rare and may be caused by direct arterial trauma during placement of the locking screws through the intramedullary nail. This article is the first, to our knowledge, to describe an occlusion of a lower extremity bypass graft after intramedullary fixation on a fracture table. Surgeons should be aware of potential limb threatening ischemia in patients with peripheral vascular disease, especially in those with prior lower extremity bypass grafts. Proper preoperative counseling should be given to these patients when using fracture tables during hip fracture surgery.
本文介绍了一例90岁女性患者的病例，该患者此前接受了用戈尔特斯移植物（戈尔医疗公司，亚利桑那州弗拉格斯塔夫）进行的股总动脉至胫前动脉搭桥术。随后，她在一次机械性跌倒后发生同侧转子间髋部骨折，并使用骨折手术台通过髓内钉进行了内固定。术后即刻，她因移植物血栓形成而出现腿部危及肢体的缺血。患者接受了成功的血栓切除术和栓子切除术。然而，在数周内她该肢体随后出现了不愈合溃疡，需要手术清创。继而发生坏疽，她接受了膝下截肢术。使用骨折手术台的并发症包括会阴软组织损伤、腿部旋转不良或对线不良、神经损伤以及健康腿部的医源性骨筋膜室综合征。股骨骨折髓内固定术后的动脉并发症罕见，可能是在通过髓内钉置入锁定螺钉时直接动脉损伤所致。据我们所知，本文是首次描述在骨折手术台上进行髓内固定后下肢搭桥移植物闭塞的情况。外科医生应意识到外周血管疾病患者，尤其是既往有下肢搭桥移植物的患者存在潜在的危及肢体的缺血情况。在髋部骨折手术中对这些患者使用骨折手术台时，应给予适当的术前咨询。
