Department of Orthopedics and Traumatology, University of Helsinki and Helsinki, University Hospital, PO Box 266, FI-00026 HUS Finland.
Department of Orthopedics and Traumatology, University of Helsinki and Helsinki, University Hospital, PO Box 266, FI-00026 HUS Finland.
Injury. 2018 Jul;49(7):1341-1347. doi: 10.1016/j.injury.2018.05.005. Epub 2018 May 21.
The removal of implants such as intramedullary nails is one of the most common operations in orthopedic surgery. The indications for orthopedic implants removal will always remain a subject of conversation and hardly supported by literature. The aim of this study to report injuries of treatment in tibial nail removal and to determine if there are fracture characteristics, patient demographics, or surgical details that may predict a complication.
This is a retrospective seven-year (2010-2016) study including a total of 389 tibial intramedullary nail removals at the Helsinki University Hospital's orthopedic unit. Patients with tibial fracture and removal of intramedullary nail were identified from the hospital discharge register and analyzed.
A total of 21 (5,4%) nail removal related mechanical complications (iatrogenic fractures, nerve injuries, failures to remove the nail) were noted. The most common complication was iatrogenic fracture (n = 15, 3,8%). In 6/15 cases the fracture was caused by broken interlocking screws, In 5/15 cases the iatrogenic fracture was caused accidentally by extracting the nail without prior removal of all distal interlocking screws. In one case, new condensed bone had formed around the nail's distal end and case the forced nail extraction caused a re-fracture in both tibia and fibula.
Nail removal can be a challenging operation which does not always receive the necessary preoperative planning or operative expertise. Iatrogenic fractures were most often caused by inadequate preoperative planning or assuming that a broken interlocking screw tilts during the extraction. We suggest the use of checklists in preoperative planning to avoid fractures caused by broken or undetected interlocking screws.
取出髓内钉等植入物是矫形外科最常见的手术之一。去除矫形植入物的适应证始终是一个讨论的话题，而且几乎没有文献支持。本研究旨在报告胫骨钉取出术的治疗损伤，并确定是否存在可能导致并发症的骨折特征、患者人口统计学特征或手术细节。
这是一项回顾性的七年（2010-2016 年）研究，共包括赫尔辛基大学医院矫形科 389 例胫骨髓内钉取出术。从医院出院记录中确定胫骨骨折和髓内钉取出的患者，并进行分析。
共发现 21 例（5.4%）与钉取出相关的机械并发症（医源性骨折、神经损伤、钉取出失败）。最常见的并发症是医源性骨折（n=15，3.8%）。在 15 例骨折中，有 6 例是由断钉的锁定螺钉引起的，在 15 例骨折中，有 5 例是由于在没有预先取出所有远端锁定螺钉的情况下意外拔出钉而导致的医源性骨折。在 1 例中，新的浓缩骨已在钉的远端周围形成，强行拔出钉导致胫骨和腓骨再次骨折。
钉取出术可能是一项具有挑战性的手术，并不总是需要进行必要的术前计划或手术专业知识。医源性骨折最常由术前计划不当或假设断钉的锁定螺钉在拔出时倾斜引起。我们建议在术前计划中使用检查表，以避免因断钉或未检测到的锁定螺钉引起的骨折。
