Suh You-Sung, Lee Won-Seok, Ahn Joonghyun, Choi Hyung-Suk, Baek Min Jung, Choi Sung-Woo
Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul.
Department of Orthopaedic surgery, Kyung Hee University hospital at Gangdong.
Medicine (Baltimore). 2020 May;99(20):e19935. doi: 10.1097/MD.0000000000019935.
The removal of bent intramedullary (IM) nail can become a challenge. Therefore, various methods have been reported for the extraction of nails after femoral refracture. We want to share our successful treatment.
Case 1. A 44-year-old man was admitted to our clinic after falling while playing soccer. He complained severe right thigh pain with a visible deformity of the femur. His medical history revealed a right femoral shaft fracture caused in a traffic accident which had been treated with intramedullary nailing. Case 2. A 27-year-old man, who had suffered a right femur fracture after a motorcycle accident and been treated with an IM nail, presented after falling down the stairs. He had severe right thigh pain without any open wound or neurologic deficit.
Case 1. Plain radiographs revealed a refracture of the right femoral shaft and a bent IM nail. The initial varus deformity of the nail was 60.1° in the coronal plane. Case 2. The valgus deformity of the nail was 16.1° with an apex-posterior angulation of 34.8° in the sagittal image of plain radiographs.
Case 1. Initial manual reduction was tried in emergency room. Then, under general anesthesia closed reduction of the fracture and bent IM nail was done. After closed reduction, the nail was straightened and extracted smoothly. Case 2. Closed manipulation was attempted initially. But no difference in the deformity was achieved. Therefore, via skin incision, the bent nail was progressively sectioned with high-speed cutting burr until the nail could be straightened.
Case 1. The patient was mobilized with partial-weight bearing assisted with a crutch on postoperative day two. One year after surgery, the fracture union was complete and the patient was pain-free. Case 2. Six months after surgery, the fracture union was complete with sufficient callus formation around the fracture site.
There is no gold standard method to remove a bent IM nail. However, since manual reduction to straighten the bent nail causes minimal soft tissue damage, it should be considered first. If it fails, other methods should be attempted, progressing from the minimally invasive technique to more invasive methods.
取出弯曲的髓内钉可能会成为一项挑战。因此，已有多种用于股骨骨折后取出髓内钉的方法被报道。我们想分享我们的成功治疗经验。
病例1。一名44岁男性在踢足球时摔倒后被收治入我院。他主诉右大腿剧痛，股骨有明显畸形。他的病史显示曾因交通事故导致右股骨干骨折，接受过髓内钉治疗。病例2。一名27岁男性，在摩托车事故后发生右股骨骨折并接受了髓内钉治疗，在从楼梯上摔下后前来就诊。他右大腿剧痛，无任何开放性伤口或神经功能缺损。
病例1。X线平片显示右股骨干骨折及一枚弯曲的髓内钉。髓内钉在冠状面的初始内翻畸形为60.1°。病例2。在X线平片矢状位图像上，髓内钉的外翻畸形为16.1°，伴有34.8°的顶点后倾成角。
病例1。在急诊室首先尝试了手法复位。然后，在全身麻醉下对骨折和弯曲的髓内钉进行了闭合复位。闭合复位后，髓内钉被拉直并顺利取出。病例2。最初尝试了闭合手法操作。但畸形无改善。因此，通过皮肤切口，用高速切割钻逐步截断弯曲的髓内钉，直至髓内钉能够被拉直。
病例1。术后第二天患者在拐杖辅助下部分负重活动。术后一年，骨折完全愈合，患者无痛。病例2。术后六个月，骨折完全愈合，骨折部位周围有足够量的骨痂形成。
取出弯曲的髓内钉尚无金标准方法。然而，由于通过手法复位拉直弯曲的髓内钉对软组织损伤最小，应首先考虑。如果失败，应尝试其他方法，从微创技术逐步过渡到更具侵入性的方法。
