Matsuda Dean K
Kaiser West Los Angeles Medical Center, Los Angeles, California, U.S.A.
Arthrosc Tech. 2012 Feb 9;1(1):e5-e10. doi: 10.1016/j.eats.2011.12.002. Print 2012 Sep.
The clamshell fracture of the femoral head and its arthroscopic osteosynthesis are described. This suprafoveal osteochondral fracture may have folded onto itself during closed reduction of the associated anterior hip dislocation. The resultant fracture fragment had almost circumferential chondral coverage that required arthroscopic manipulation to "pry apart the clamshell," permitting arthroscopic reduction. This patient also had pre-existing silent femoroacetabular impingement, and the novel use of arthroscopic acetabuloplasty permitted internal fixation by improving the path for headless screw fixation. The arthroscopic techniques and clinical outcome at greater than 2 years are presented. Albeit rare, the clamshell fracture configuration should be recognized and may be amenable to successful arthroscopic osteosynthesis. Of broader clinical impact and application, adjunctive acetabuloplasty may permit the successful osteosynthesis of select femoral head fractures in patients with concurrent acetabular overcoverage by completely arthroscopic techniques that engage both the fracture fragment and the attractive benefits of less invasive surgery.
描述了股骨头的蛤壳样骨折及其关节镜下骨固定术。这种髋臼上缘骨软骨骨折在相关髋关节前脱位的闭合复位过程中可能发生了自身折叠。由此产生的骨折碎片几乎有圆周软骨覆盖，这需要关节镜操作来“撬开蛤壳”，从而实现关节镜下复位。该患者还存在先前未被发现的股骨髋臼撞击症，关节镜下髋臼成形术的新应用通过改善无头螺钉固定的路径而允许进行内固定。介绍了关节镜技术及超过2年的临床结果。尽管蛤壳样骨折形态罕见，但应予以识别，并且可能适合成功的关节镜下骨固定术。具有更广泛临床影响和应用的是，辅助髋臼成形术可能通过完全关节镜技术使同时存在髋臼覆盖过度的特定股骨头骨折成功进行骨固定，这些技术既能处理骨折碎片，又具有微创手术的诸多益处。
