Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO; and Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX.
J Orthop Trauma. 2022 Dec 1;36(12):458-462. doi: 10.1097/BOT.0000000000002418.
Fixation of subtrochanteric femur fractures using intramedullary nails can provide high rates of osseous union. However, a lateral starting point or a medial trajectory can result in varus alignment, typically seen with trochanteric entry nails. Even with piriformis nails, medial comminution can result in secondary malalignment and varus. Varus can predictably result in nonunion and need for repeat operations. Medialized trochanteric entry nailing has been reported previously as a method to prevent varus alignment in low-energy, atypical subtrochanteric femur fractures in association with bisphosphonate use. We present a surgical technique using a medialized trochanteric nail entry point to provide proper alignment and avoidance of varus malreduction in 24 patients with a subtrochanteric femur fracture after a high-energy traumatic event.
使用髓内钉固定转子下股骨骨折可以实现较高的骨愈合率。然而，外侧入点或内侧入路可能导致内翻对线，这在转子间入钉中很常见。即使使用梨状肌钉，内侧粉碎也可能导致继发对线不良和内翻。内翻可预测性地导致骨不连和需要重复手术。髓内钉入点内侧化已被报道可预防低能量、非典型转子下股骨骨折与双膦酸盐使用相关的内翻对线。我们介绍了一种使用髓内钉入点内侧化的手术技术，在 24 例高能创伤性事件后发生的转子下股骨骨折患者中，提供了适当的对线并避免了内翻对线不良。
