Wang Chaoqun, Wang Qingxian
Department of Geriatric Orthopedics, Traumatic Emergency Center, Hebei Provincial Biomechanical Key Laboratory, Hebei Provincial Othopedic Institute, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Medicine (Baltimore). 2019 Jul;98(30):e16584. doi: 10.1097/MD.0000000000016584.
Femoral intertrochanteric fracture happens easily in the elderly, especially those with osteoporosis. As a standard intramedullary fixation implant, Proximal Femoral Nail Anti-rotation (PFNA) is applied to various types of stable or unstable intertrochanteric fractures of femur. Due to blade-related factors, such as cutting-through into the hip joint, cutting out or back out, there are endless postoperative failure cases of internal fixation, but reports about perioperative failure that the helical blade cannot be tightened are lacking. In this case, we firstly report an intraoperative blade compression failure and an effective technique to help surgeons out of the dilemma by using cannulated hexagonal screwdriver which was already included in the orthopedic instrument box.
An 81-year-old lady suffered left hip pain, swelling and limitation of activity, after slipping and falling when she was in the toilet.
X-ray and computed tomography (CT)-scan showed comminuted left intratrochanteric fracture with a Jensen classification of IIa type.
The patient was treated by closed reduction and internal fixation with PFNA. We suffered an unprecedented problem that helical blade cannot be tightened by the blade impactor as usual. For fear of helical blade disintegration during removal and a significant decrease in pullout strength after reinsertions, we eliminated the dilemma by using a cannulated hexagonal screwdriver to tighten the "problem" helical blade.
The "problem" helical blade was finally locked by using the SW4.0 mm cannulated hexagonal screwdriver which was already included in the instrument box. The operation ended successfully after completing subsequent steps.
The cannulated hexagonal screwdriver is an effective instrument that can help surgeons out of the dilemma when the blade impactor fails to tighten the helical blade in PFNA implantation.
股骨转子间骨折在老年人中很容易发生，尤其是那些患有骨质疏松症的人。作为一种标准的髓内固定植入物，股骨近端抗旋髓内钉（PFNA）适用于各种类型的稳定或不稳定的股骨转子间骨折。由于与刀片相关的因素，如切入髋关节、穿出或退出，内固定术后失败病例层出不穷，但关于螺旋刀片无法拧紧的围手术期失败的报道却很少。在本病例中，我们首次报告了术中刀片加压失败的情况，以及一种通过使用骨科器械箱中已有的空心六角螺丝刀来帮助外科医生摆脱困境的有效技术。
一名81岁女性在厕所滑倒后，出现左髋部疼痛、肿胀及活动受限。
X线和计算机断层扫描（CT）显示左转子间粉碎性骨折，Jensen分类为IIa型。
对患者行闭合复位并采用PFNA内固定治疗。我们遇到了一个前所未有的问题，即螺旋刀片无法像往常一样用刀片打入器拧紧。由于担心在取出过程中螺旋刀片解体以及重新插入后拔出力显著降低，我们使用空心六角螺丝刀拧紧“问题”螺旋刀片，从而摆脱了困境。
最终使用器械箱中已有的SW4.0毫米空心六角螺丝刀锁定了“问题”螺旋刀片。完成后续步骤后，手术成功结束。
在PFNA植入过程中，当刀片打入器无法拧紧螺旋刀片时，空心六角螺丝刀是一种能帮助外科医生摆脱困境的有效器械。
