Arora Sumit, Maini Lalit, Aggarwal Vinay, Dhal Anil
Department of Orthopedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
Indian J Orthop. 2012 Jan;46(1):109-12. doi: 10.4103/0019-5413.91646.
Broken implants, especially broken wires at difficult sites, may pose a challenge for the treating orthopedic surgeon. We describe a method for extraction of a broken guidewire that was, protruding into the hip joint following the insertion of a proximal femoral nail. A 35-year-old man with displaced femoral neck fracture with ipsilateral fracture shaft of femur was operated and fixed with long proximal femoral nail. The guidewire of proximal screw broke during the process of drilling. The tip of the 2-cm-long broken guidewire was touching the articular surface. The guidewire was misdirected posteroinferiorly from its path for the insertion of the proximal screw (6.8 mm), this screw was removed and bone endoscopy was performed with a 30° arthroscope. The broken end of the guidewire was located under direct vision. The grasper was introduced with its jaws at the 8 O'clock position and its position was confirmed under a C-arm image intensifier in both anteroposterior and lateral views. The broken end of the guidewire was grasped and it was retrieved. The screw was replaced in its original track to complete the procedure. The fractures united and patient was asymptomatic when last followed-up at 12 months.
植入物断裂，尤其是在困难部位的钢丝断裂，可能给骨科治疗医生带来挑战。我们描述了一种取出断裂导丝的方法，该导丝在股骨近端髓内钉插入后突入髋关节。一名35岁男性，股骨颈移位骨折合并同侧股骨干骨折，接受手术并用长型股骨近端髓内钉固定。近端螺钉的导丝在钻孔过程中折断。2厘米长的断丝尖端触及关节面。导丝从近端螺钉（6.8毫米）插入路径向后下方偏移，取出该螺钉，并用30°关节镜进行骨内窥镜检查。在直视下找到导丝的断端。将抓取器以钳口位于8点钟位置插入，在C形臂影像增强器的前后位和侧位视图下确认其位置。抓住导丝的断端并将其取出。将螺钉沿原轨道重新置入以完成手术。骨折愈合，患者在12个月的最后一次随访时无症状。
