Barimani Bardia, Khan Kashif, Abduljabbar Fahad, Volesky Monica, Antoniou John
Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada.
Department of Experimental Surgery, McGill University Health Centre, Montreal, Canada.
Trauma Case Rep. 2020 Mar 7;26:100290. doi: 10.1016/j.tcr.2020.100290. eCollection 2020 Apr.
Osteoporotic patients being treated with bisphosphonates present an interesting dilemma when removing hardware such as dynamic hip screws "DHS". In this paper, we describe the case of a 66-year-old osteoporotic patient who was placed on long term bisphosphonate therapy after sustaining an intertrochanteric hip fracture which was stabilized with a DHS. She presented with a subtrochantric fracture on the ipsilateral side. She was planned for DHS removal and intramedullary nailing. Removal of the dynamic hip screw proved to be difficult, likely due to possible cold welding of the DHS to the barrel of the side plate and sclerotic bone formation around the hardware secondary to the extended bisphosphonate use. The patient had an intra-operative femoral neck fracture while attempting the DHS removal. We had to convert to an unanticipated total hip replacement. Careful considerations should be taken when removing hardware from patients on long term bisphosphonate treatment.
对于正在接受双膦酸盐治疗的骨质疏松患者，在取出诸如动力髋螺钉（DHS）等内固定装置时会面临一个有趣的难题。在本文中，我们描述了一名66岁骨质疏松患者的病例，该患者在转子间髋部骨折后接受了长期双膦酸盐治疗，骨折用DHS固定。她出现了同侧转子下骨折。计划为其取出DHS并进行髓内钉固定。事实证明，取出动力髋螺钉很困难，这可能是由于DHS与侧板的桶形部分可能发生冷焊，以及长期使用双膦酸盐导致内固定装置周围形成硬化骨。患者在尝试取出DHS时发生了术中股骨颈骨折。我们不得不转为进行意外的全髋关节置换。对于长期接受双膦酸盐治疗的患者，在取出内固定装置时应谨慎考虑
