Takeba Jun, Imai Hiroshi, Kikuchi Satoshi, Matsumoto Hironori, Moriyama Naoki, Nakabayashi Yuki
Department of Emergency Medicine and Critical Care, Ehime University, Shitsukawa, Toon, Ehime 791-0295. Japan.
Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295. Japan.
J Orthop Case Rep. 2020 Oct;10(7):76-79. doi: 10.13107/jocr.2020.v10.i07.1926.
It is difficult to use a traction table during surgery for an ipsilateral displaced femoral trochanteric fracture following above-the-knee amputation. However, there are few reports regarding such cases. We describe the simple method we used for positioning the traction table and reducing fracture site during fixation surgery for a displaced femoral trochanteric fracture in this patient following above-the-knee amputation.
An 80-year-old man was injured in a head-on collision with an oncoming vehicle. We diagnosed him with traumatic gastric perforation, multiple right lower leg fractures, and right lower leg severe crush wound. We performed right above-the-knee amputation and laparoscopic gastrorrhaphy for lifesaving purposes. Thereafter we performed internal fixation for the right femoral trochanteric fracture on the 5th day after the injury. In that operation, we first inserted a 2.4 mm Kirschner wire under fluoroscopic guidance 3 cm proximal to the femoral cut end and attached a horseshoe and traction rope to it. Then, we tightened the rope to the foot piece of the traction table and secured it. Although shortening of the bone fracture was reduced by traction, rotation control was impossible; therefore, the horseshoe was manually controlled through clean sheets during surgery to reduce rotational displacement. We performed internal fixation surgery using a trochanteric femoral nail in the usual manner.
In the osteosynthesis surgery of displaced femoral trochanteric fractures following above-the-knee amputation, the method of inserting the Kirschner wire at the distal end of the patient's femur and pulling it through the rope enables surgeons to reduce fracture shortening. Reduction of rotational displacement was possible by controlling the horseshoe by hand. In this way, intramedullary nail fixation could be performed without trouble under fluoroscopic guidance.
对于膝上截肢术后同侧移位股骨转子间骨折的患者，术中使用牵引床存在困难。然而，关于此类病例的报道较少。我们描述了在该膝上截肢患者的移位股骨转子间骨折固定手术中，用于放置牵引床和复位骨折部位的简单方法。
一名80岁男性在与迎面驶来的车辆正面碰撞中受伤。我们诊断他患有创伤性胃穿孔、右下肢多处骨折以及右下肢严重挤压伤。为挽救生命，我们进行了右膝上截肢术和腹腔镜胃缝合术。此后，在受伤后第5天，我们对右股骨转子间骨折进行了内固定手术。在那次手术中，我们首先在透视引导下于股骨断端近端3 cm处插入一根2.4 mm克氏针，并在其上连接一个马蹄形装置和牵引绳。然后，我们将绳子拉紧至牵引床的脚踏板并固定。尽管通过牵引减少了骨折缩短，但无法控制旋转；因此，在手术过程中通过干净的床单手动控制马蹄形装置以减少旋转移位。我们以常规方式使用股骨转子钉进行了内固定手术。
在膝上截肢术后移位股骨转子间骨折的骨固定手术中，在患者股骨远端插入克氏针并通过绳索牵拉的方法能够使外科医生减少骨折缩短。通过手动控制马蹄形装置可以减少旋转移位。通过这种方式，可以在透视引导下顺利进行髓内钉固定。
