Haubruck Patrick, Brunnemer Ulf, Moghaddam Arash, Schmidmaier Gerhard
Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Germany.
Orthop Rev (Pavia). 2017 Jan 4;8(4):6738. doi: 10.4081/or.2016.6738. eCollection 2016 Nov 17.
A case of an adolescent female patient who suffered from first grade open multi-fragment fracture of the tibia (AO42-C2) with a large hypermobile intermediate fragment is presented in this case report. Intramedullary nailing of the tibia remains the treatment of choice despite a high risk of malformation and anterior knee pain especially in multi-fragment fractures. Here the suprapatellar approach as a semiextended nailing technique seems favorable. The specialty in our case was an early change of procedures necessary due to persistent swelling during external fixation based on the hypermobile intermediate fragment. Decision in favor of this surgical technique was conducted in order to achieve beneficial alignment and union while protecting the soft-tissue despite the hypermobile intermediate fragment and decrease the risk of anterior knee pain. In our case we achieved successful alignment and proper bone healing without any signs of anterior knee pain or limitations in the range of motion of the knee. With this report we would like to recommend the suprapatellar approach as a favorable alternative in intramedullary nailing in this type of fracture also in young patients.
本病例报告介绍了一名青春期女性患者，其患有胫骨一级开放性多段骨折（AO42-C2），伴有一个活动度大的中间骨折块。尽管畸形风险高且尤其是多段骨折时前膝疼痛风险高，但胫骨髓内钉固定仍是首选治疗方法。在此，髌上入路作为一种半伸展式钉固定技术似乎是有利的。我们病例的特殊之处在于，由于基于活动度大的中间骨折块在外部固定期间持续肿胀，需要早期改变手术程序。做出采用这种手术技术的决定是为了在存在活动度大的中间骨折块的情况下，实现良好的对线和愈合，同时保护软组织，并降低前膝疼痛的风险。在我们的病例中，我们成功实现了对线并使骨折顺利愈合，没有任何前膝疼痛的迹象或膝关节活动范围受限的情况。通过本报告，我们想推荐髌上入路作为这类骨折（包括年轻患者）髓内钉固定的一种有利替代方法。
