Krettek C, Mommsen P
Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30173, Hannover, Deutschland.
Unfallchirurg. 2012 Apr;115(4):299-314. doi: 10.1007/s00113-012-2158-3.
We present a literature review about implant removal after intramedullary stabilization of femoral or tibial shaft fractures, upper extremity fractures, and pediatric fractures. A special focus is the difficult implant removal. Implant removal of nails gets difficult when implants are bent or broken. Other difficulties include broken interfaces between nail and removal instrument or when bone ingrowth hinders extraction. A special difficulty is posed by broken solid nails. Implant failure shows typical failure patterns regarding the location of the fatigue fracture. Based on well-documented clinical cases, we describe in detail surgical techniques as well as tips and tricks which help in the difficult circumstances of bent or broken implants in proximal, midshaft, or distal nail segments for a large variety of implants (solid, cannulated, slotted). We also describe an elegant technique for the safe removal of an infected cemented arthrodesis nail. The time required to perform a nail removal can easily exceed the planned amount. Nail removal can result in significant complications like soft tissue damage, fractures, infections, and other problems. Not only because of these problems, the decision on whether or not to remove the nail should be made with great care. Therefore, good communication with the patient and thorough information about risks and benefits are essential.
我们对股骨或胫骨干骨折、上肢骨折及儿童骨折髓内固定后取出植入物的相关文献进行了综述。特别关注的是困难的植入物取出情况。当植入物弯曲或折断时，取出髓内钉会变得困难。其他困难包括髓内钉与取出器械之间的接口断裂，或骨长入阻碍取出。折断的实心髓内钉会带来特殊困难。植入物失败在疲劳骨折位置方面呈现出典型的失败模式。基于充分记录的临床病例，我们详细描述了手术技术以及技巧，这些技巧有助于在近端、骨干中部或远端髓内钉段遇到弯曲或折断植入物的困难情况下取出各种类型的植入物（实心、空心、开槽）。我们还描述了一种安全取出感染的骨水泥固定关节融合髓内钉的巧妙技术。取出髓内钉所需的时间很容易超过计划时间。取出髓内钉可能导致严重并发症，如软组织损伤、骨折、感染及其他问题。不仅因为这些问题，决定是否取出髓内钉时应格外谨慎。因此，与患者进行良好沟通并充分告知风险和益处至关重要。
