Giordano Vincenzo, Parilha Coutinho Bruno, Miyahira Mateus Kenji, de Souza Felipe Serrão Mendes, do Amaral Ney Pecegueiro
Serviço de Ortopedia e Traumatologia Professor Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil.
Núcleo Especializado de Ortopedia e Traumatologia, Clínica São Vicente, Rio de Janeiro, RJ, Brazil.
Case Rep Orthop. 2017;2017:1650194. doi: 10.1155/2017/1650194. Epub 2017 May 18.
We present the case of a patient who suffered a comminuted supracondylar periprosthetic femur fracture. The patient was an 86-year-old lady who suffered a minor fall at home and presented at our hospital with a right comminuted distal femur fracture around a total knee arthroplasty. The patient was submitted to a cruciate-sacrificing total knee replacement 6 years before at the same institution. Despite severe metaphyseal fragmentation and short distal fragment, the prosthesis was stable; thus, open fracture reduction and stabilization with internal fixation were performed. The surgical technique included the use of a nonvascularized autologous fibular strut graft as an augmentation technique in conjunction with double plating fixation. Clinically, patient presented a painless aligned knee 12 months after femur fixation, although she was not able to return to an independent level of activity. No pain involving the donor graft site was reported at the time of the most recent follow-up examination. This case study demonstrates the use of free nonvascularized autogenous fibular strut bone graft as an option to bridge major bone defects. This proved to be a relatively simple, not expensive procedure that can be done percutaneously and does not need high-quality training.
我们报告一例发生髁上假体周围股骨粉碎性骨折的患者。该患者为一名86岁女性，在家中轻微跌倒后因全膝关节置换术周围的右股骨远端粉碎性骨折前来我院就诊。患者6年前在同一机构接受了保留交叉韧带的全膝关节置换术。尽管存在严重的干骺端碎裂和远端短缩骨折块，但假体稳定；因此，进行了切开复位并采用内固定进行稳定。手术技术包括使用非血管化自体腓骨支撑骨移植作为一种增强技术，并结合双钢板固定。临床上，股骨固定12个月后患者膝关节对线良好且无痛，尽管她未能恢复到独立活动水平。在最近的随访检查时，未报告供体骨移植部位有疼痛。本病例研究证明了使用游离非血管化自体腓骨支撑骨移植作为桥接主要骨缺损的一种选择。这被证明是一种相对简单、费用不高的手术，可经皮完成，且不需要高质量的培训。
