Jin Jin-Woo, Kim Hyeon-Soo, Jang Min-Jae
Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Geyongsangnam-do, Republic of Korea.
Geriatr Orthop Surg Rehabil. 2022 Mar 12;13:21514593221074179. doi: 10.1177/21514593221074179. eCollection 2022.
Hardware removal in a healed intertrochanteric fracture in elderly, which is not a routine procedure, should be needed in the case of irritable hardware. The reports of refracture after hardware removal can be seen as sparse in current literature, which are focused to secondary femoral neck fracture after removal of the lag screw or blade. We experienced a case of the intertrochanteric refracture and varus collapse after the PFNA removal in a healed fracture, treated with valgus trochanteric osteotomy and angled blade plate fixation. The PFNA is an innovative device for the treatment of the trochanteric fracture; however, the complications after removal never end. Therefore, the removal from healed fracture in elderly who have osteoporosis should not be recommended unless intractable pain had persisted.
对于老年患者已愈合的粗隆间骨折取出内固定物,这并非常规操作,只有在内固定物引起不适的情况下才需要进行。目前文献中关于取出内固定物后再骨折的报道较少,这些报道主要集中在拉力螺钉或刀片取出后继发的股骨颈骨折。我们遇到一例已愈合骨折在取出股骨近端防旋髓内钉(PFNA)后发生粗隆间再骨折和内翻塌陷的病例,采用粗隆间外翻截骨术和角状钢板固定进行治疗。PFNA是治疗粗隆间骨折的一种创新器械;然而,取出后的并发症却层出不穷。因此,除非持续存在难以忍受的疼痛,否则不建议对患有骨质疏松症的老年患者已愈合骨折取出内固定物。