Lee Kyung-Jae, Min Byung-Woo, Jung Jae-Hoon, Kang Mi-Kyung, Kim Min-Ji
Department of Orthopaedic Surgery, School of Medicine, Keimyung University, Daegu, Republic of Korea; Pain Research Center, School of Medicine, Keimyung University, Daegu, Republic of Korea.
Department of Orthopaedic Surgery, School of Medicine, Keimyung University, Daegu, Republic of Korea.
Int J Surg Case Rep. 2015;10:158-61. doi: 10.1016/j.ijscr.2015.03.048. Epub 2015 Mar 28.
Subtrochanteric femoral fractures are relatively uncommon, accounting for 7-15% of all hip fractures and treatment of these fractures are considered challenge for orthopaedic surgeons. Although several treatment options are reported with up to 90% of satisfactory results, the choice of the appropriate implant is still a matter of debate. Some authors reported thermal injury after reaming for intramedullary nail fixation in patients with narrow medullary canal.
A 21-year-old female patient was admitted to our hospital because of right subtrochanteric femoral fracture. The narrowest diameter of medullary canal of her femur was about 7mm but she refused open reduction and internal fixation with plate due to large scar formation. We used expert tibia nail instead of femoral intramedullary nail to prevent thermal injury.
Subtrochanteric femoral fractures are difficult to treat because of their biomechanical and anatomical characteristics. Although several implants are reported for the surgical treatment of these fractures, intramedullary nails have been advocated due to their biological and biomechanical advantages. However, under certain circumstances with associated injury or anatomic difference we might consider another treatment options.
Expert tibia nail may be considered one of the treatment options for subtrochanteric femoral fracture with narrow medullary canal. We also emphasize the importance of preoperative evaluation of the medullary canal size for these risky fractures.
股骨转子下骨折相对少见，占所有髋部骨折的7% - 15%，其治疗被认为是骨科医生面临的挑战。尽管报道了几种治疗方案，且效果满意率高达90%，但合适植入物的选择仍存在争议。一些作者报道了髓腔狭窄患者在髓内钉固定扩髓后出现热损伤。
一名21岁女性患者因右股骨转子下骨折入院。其股骨髓腔最窄直径约为7mm，但由于会形成较大瘢痕，她拒绝切开复位钢板内固定。我们使用专家型胫骨钉而非股骨髓内钉以防止热损伤。
股骨转子下骨折因其生物力学和解剖学特点而难以治疗。尽管报道了几种用于手术治疗这些骨折的植入物，但由于髓内钉具有生物学和生物力学优势，一直受到推崇。然而，在某些伴有相关损伤或解剖差异的情况下，我们可能会考虑其他治疗方案。
专家型胫骨钉可被视为髓腔狭窄的股骨转子下骨折的治疗选择之一。我们还强调了对这些高风险骨折进行术前髓腔大小评估的重要性。
