Department of Trauma and Reconstructive Surgery, BG Hospital Tübingen, Germany.
Department of Trauma and Reconstructive Surgery, Diakonie Klinikum Jung-Stillig, Siegen, Germany.
Z Orthop Unfall. 2021 Feb;159(1):98-100. doi: 10.1055/a-1298-4997. Epub 2020 Dec 17.
Torsional deformity is a frequent complication following nail osteosynthesis of a subtrochanteric fracture. This complication is difficult to assess intraoperatively, but can cause major functional restrictions. The authors consider that a clinical assessment should be complemented by a postoperative radiological control standardised with torsion CT. Thus, torsion deformity can be recognised immediately and easily corrected if necessary. This can help to avoid long-term damage that requires considerable surgery. The video shows details of torsion correction after a ca. 5-week old subtrochanteric femoral fracture, which had been initially treated with a femur nail. Before torsion correction, the internal torsion on the right femur was 22° and the external torsion on the left femur was 2°. Thus, the total deformation of the external torsion on the left side was 24°. We note the indication for removal of the nail, torsion correction and reosteosynthesis with long PFNA. The postoperative CT control confirmed that the torsion correction was adequate with internal torsion of 25° on the operated left side.
转子间骨折髓内钉固定术后常发生扭转畸形。这种并发症在术中难以评估，但会导致严重的功能受限。作者认为，临床评估应辅以术后与扭转 CT 标准化的放射学对照。因此，如果需要，可立即识别并轻松纠正扭转畸形。这有助于避免需要大量手术的长期损害。该视频展示了在股骨粗隆下骨折约 5 周后，用股骨钉初步治疗后，纠正扭转畸形的细节。在进行扭转纠正之前，右侧股骨的内扭转为 22°，左侧股骨的外扭转为 2°。因此，左侧外扭转的总变形为 24°。我们注意到需要取出钉子，进行扭转纠正，并使用长型 PFNA 重新进行骨固定。术后 CT 检查证实，左侧手术侧的内扭转为 25°，扭转纠正充分。
