Miyamoto Shuichi, Iida Satoshi, Nakatani Takushi, Yamagata Hiroyuki, Nakamura Junichi, Orita Sumihisa, Ohtori Seiji
Matsudo City General Hospital, 993-1 Sendabori, Matsudo City, Chiba 270-2296, Japan.
Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan.
Trauma Case Rep. 2020 Jun 30;28:100326. doi: 10.1016/j.tcr.2020.100326. eCollection 2020 Aug.
AO/OTA type 31-A1.2 intertrochanteric femoral fractures generally are considered stable intertrochanteric fractures. We report a case of an unstable AO/OTA type 31-A1.2 intertrochanteric femoral fracture. Primary internal fixation was performed with a long cephalomedullary nail taking instability into account. Postoperative X-rays showed an acceptable reduction with a slight fracture gap in extension on the lateral trochanteric side. However, additional salvage surgery was required because the long cephalomedullary nail broke as a result of the instability caused by non-union and varus deformity of the proximal femur. More attention should be directed to strategies of primary internal fixation including choice of fixation instrumentation in terms of mechanical stability because this type of fracture can be remarkably unstable despite radiographic diagnosis of a usually stable AO/OTA classification type 31-A1.2 fracture.
AO/OTA 31-A1.2型股骨转子间骨折一般被认为是稳定的转子间骨折。我们报告一例不稳定的AO/OTA 31-A1.2型股骨转子间骨折病例。考虑到骨折的不稳定性，采用加长型髓内钉进行一期内固定。术后X线片显示骨折复位可接受，转子外侧在伸直位有轻微骨折间隙。然而，由于股骨近端骨不连和内翻畸形导致的不稳定，加长型髓内钉断裂，需要进行额外的挽救手术。应更加关注一期内固定策略，包括根据机械稳定性选择固定器械，因为尽管影像学诊断为通常稳定的AO/OTA 31-A1.2型骨折，但这类骨折可能非常不稳定。
