Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea.
Department of Orthopaedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
Arch Orthop Trauma Surg. 2021 Jun;141(6):959-969. doi: 10.1007/s00402-020-03620-2. Epub 2020 Oct 10.
Although reconstruction nails have an advantage of single-construct fixation in ipsilateral femoral neck and shaft fractures, they have not been used widely due to the technical challenges associated with their placement. Reduction is particularly demanding in patients with displaced neck fractures after nailing of the shaft fracture, and can be resulted in nonunion, malunion, and osteonecrosis. We report a new technique of reconstruction nailing after the provisional reduction and fixation of a neck fracture to achieve successful healing of this injury.
Osteosynthesis using a reconstruction nail was performed in ten consecutive patients with displaced femoral neck and shaft fracture. After closed reduction of the displaced neck fracture, the femoral neck was provisionally fixed with pins in an anterolateral-to-medial direction. While maintaining reduction of the neck fracture, a nail was inserted and passed into the medullary canal posterior to the provisionally fixed pins with indirect reduction of the shaft fracture. After two reconstruction locking screws were fixed for proximal interlocking, the provisional pins were removed once distal interlocking was achieved. The radiologic outcomes included quality of reduction, healing rate, and time to the union were appraised, and the functional outcomes were assessed with Friedman and Wyman's criteria.
This novel technique provided satisfactory reduction of both the femoral neck and shaft fractures with no malunion. All fractures achieved primary union, except for one case of nonunion of femoral shaft. Eight of ten patients experienced good results in functional outcome, whereas the remaining two patients reported moderate limitations in activities of daily living. At the latest follow-up, all patients had excellent range of motion in hip and knee joints.
Provisional fixation after reduction of a femoral neck fracture may facilitate successful reconstruction nailing in the ipsilateral fractures of the femoral neck and shaft. This "Reverse Miss-a-Nail Technique" may minimize complications and maximize the radiologic and functional outcomes of patients who experience this injury.
尽管重建钉在同侧股骨颈和股骨干骨折中具有单一结构固定的优势，但由于其放置的技术挑战，它们尚未广泛应用。在股骨干骨折后行钉固定的颈骨折患者中，复位尤其具有挑战性，可能导致骨折不愈合、畸形愈合和骨坏死。我们报告了一种新的技术，即通过临时复位和固定颈骨折来进行重建钉固定，从而成功治疗这种损伤。
连续 10 例移位股骨颈和股骨干骨折患者采用重建钉进行骨内固定。闭合复位移位的颈骨折后，用前外侧到内侧方向的钢针临时固定股骨颈。在维持颈骨折复位的同时，将一枚钉插入髓腔，并通过间接复位股骨干骨折，使钉穿过临时固定的钢针的后方。完成近端交锁后固定 2 枚重建锁定螺钉，一旦实现远端交锁，即可取出临时钢针。评估放射学结果包括复位质量、愈合率和愈合时间，采用 Friedman 和 Wyman 标准评估功能结果。
该新技术提供了满意的股骨颈和股骨干骨折复位，无畸形愈合。所有骨折均实现了主要愈合，除 1 例股骨干骨折不愈合外。10 例患者中有 8 例在功能结果方面有良好的结果，而其余 2 例患者报告在日常生活活动方面有中度限制。在最新的随访中，所有患者的髋关节和膝关节活动度均良好。
颈骨折复位后的临时固定可能有助于同侧股骨颈和股骨干骨折的成功重建钉固定。这种“反向 Miss-a-Nail 技术”可能会减少并发症，最大限度地提高发生这种损伤的患者的放射学和功能结果。
