Mencia Marlon M, Moonsie Reena
Bungalow 5, Department of Clinical Surgical Sciences, University of the West Indies, Port of Spain General Hospital, Port of Spain, Trinidad, West Indies, Trinidad and Tobago.
Eric Williams Medical Sciences Complex, University of the West Indies, Champ Fleur, Trinidad, West Indies, Trinidad and Tobago.
Int J Surg Case Rep. 2022 Oct;99:107679. doi: 10.1016/j.ijscr.2022.107679. Epub 2022 Sep 19.
Intramedullary nailing is the treatment of choice for femoral shaft fractures in adults with excellent clinical results and low complication rates reported in the literature. However, in situ bending of a femoral nail is a rare complication that merits special attention. While there are several extraction techniques and algorithms the scientific evidence to support these decision-making tools is unconvincing.
A 26-year old man presented to the Accident and Emergency Department with a deformed thigh following a low-energy injury. Radiographs showed a bent femoral nail in situ and the patient disclosed that he had surgery four weeks earlier for a fractured femur sustained in a motor vehicle accident. A treatment algorithm was followed in planning the surgical strategy, but ultimately a simple hacksaw blade was used to cut and remove the nail. The fracture which was stabilised by exchange nailing went on to uncomplicated union and the patient recovered fully.
Non-invasive methods of removing a bent femoral nail are often unsuccessful and may result in iatrogenic injuries. Surgeons should assess the available local resources and first consider using simple open methods when attempting to remove a bent femoral nail.
Open extraction methods often disregard the low-resource environment in which many surgeons work. We describe a simple and economical technique that uses a regular hacksaw blade to cut and remove a bent femoral nail.
髓内钉固定术是治疗成人股骨干骨折的首选方法，文献报道其临床效果良好且并发症发生率低。然而，股骨髓内钉原位弯曲是一种罕见的并发症，值得特别关注。虽然有几种取出技术和算法，但支持这些决策工具的科学证据并不令人信服。
一名26岁男性因低能量损伤后大腿畸形就诊于急诊科。X线片显示股骨髓内钉原位弯曲，患者透露他四周前因机动车事故导致股骨骨折接受了手术。在制定手术策略时遵循了一种治疗算法，但最终使用了一把简单的锯条来切割并取出髓内钉。通过更换髓内钉固定的骨折顺利愈合，患者完全康复。
去除弯曲股骨髓内钉的非侵入性方法往往不成功，可能导致医源性损伤。外科医生应评估可用的当地资源，在试图取出弯曲的股骨髓内钉时首先考虑使用简单的开放方法。
开放取出方法往往忽视了许多外科医生工作的资源匮乏环境。我们描述了一种简单且经济的技术，使用普通锯条来切割并取出弯曲的股骨髓内钉。
