Dragosloveanu Şerban, Dragosloveanu Christiana D M, Stanca Horia T, Cotor Dragoş C, Dragosloveanu Călin I, Stoica Cristian I
Department of Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Orthopedic Surgery, 'Foişor' Orthopedics‑Traumatology and Osteoarticular TB Hospital, 030167 Bucharest.
Exp Ther Med. 2020 Dec;20(6):216. doi: 10.3892/etm.2020.9346. Epub 2020 Oct 15.
Uncommon causes of nail failures and surgical reinterventions were determined. The study included 23 osteoporotic patients, 13 of whom followed a fast recovery program with early walking (FWB group). The other 10 patients were not allowed full weight bearing until 6 weeks (NFWB group). The T-score was determined before surgery for all cases. A case with a nail breakage after a failed DCS implant fixed in another clinic was also analyzed. The nail was revised and the broken implant underwent a metallurgic and microscopic examination. The average T-score was 2.5 for the patients that followed the fast recovery program and 2.7 for the patients from non-full weight bearing. Four patients, 1 from the NFWB group and 3 from FWB group, presented a screw cut-out. It was found that the errors of the guiding instruments may create dents, scratches or micro-fractures on the titanium coating that lead to an early implant failure. Imperfect reduction leads to incorrect implant placement and a high incidence of failure. Damaging the titanium protective coating, in a low force, high cycles scenario can cause structural failure. Delays in fracture healing and material fatigue are the most common causes of nail failure and can lead to catastrophic complications.
确定了钉失败和手术再次干预的罕见原因。该研究纳入了23名骨质疏松患者，其中13名遵循快速康复计划并早期负重行走（早期负重行走组）。另外10名患者直到6周后才允许完全负重（非完全负重组）。对所有病例在手术前测定T值。还分析了1例在另一家诊所植入失败的DCS钉断裂的病例。对钉进行了翻修，并对断裂的植入物进行了金相和显微镜检查。遵循快速康复计划的患者平均T值为2.5，非完全负重患者的平均T值为2.7。4名患者出现螺钉穿出，其中1名来自非完全负重组，3名来自早期负重行走组。发现导向器械的误差可能在钛涂层上造成凹痕、划痕或微骨折，从而导致植入物早期失败。复位不完善会导致植入物放置不正确和高失败率。在低力、高循环情况下损坏钛保护涂层会导致结构失效。骨折愈合延迟和材料疲劳是钉失败的最常见原因，可导致灾难性并发症。
