Zhu Qing-hua, Ye Tian-wen, Guo Yong-fei, Wang Chong-li, Chen Ai-min
Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Chin J Traumatol. 2013;16(4):237-9.
Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS). Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV fracture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotating around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the broken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixation was easily finished. The patient had an uneventful recovery without avascular necrosis of femoral head or non-union of the fracture at one year's follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful.
导丝在动力髋螺钉（DHS）固定股骨颈骨折中起着重要作用。手术过程中导丝断裂是一种非常罕见的情况。我们在为一名54岁男性患者进行DHS固定时遇到了这样的困境，该患者右侧股骨颈为Garden IV型骨折。导丝远端断裂并被困在骨折的股骨颈内。我们试图用空心钻取出断裂部分。用空心钻围绕导针K缓慢旋转开始扩孔，直到扩孔钻在荧光透视下完全容纳目标物。用骨刮匙取出断裂的导丝但未成功，所以我们不得不使用空心钻疏通这个骨隧道。最后取出了断裂的导丝末端，其与血液和骨碎片混合在一起。通过现有的钻孔通道，很容易完成了DHS固定。患者恢复顺利，在一年的随访中未出现股骨头缺血性坏死或骨折不愈合。处理断裂导丝可以采用几种方法。我们病例中使用的方法侵入性较小，但技术上具有挑战性。当导丝位置合适时，这种方法非常实用且有效。
