Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China.
Orthop Surg. 2023 Mar;15(3):906-911. doi: 10.1111/os.13656. Epub 2023 Jan 29.
Implant cut-out or cut-through remains a common cause of cephalomedullary nail failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. In patients not suitable for conversion to total hip arthroplasty, which can involve long operation times and substantial blood loss, as well as a higher risk of periprosthetic fracture and dislocation postoperatively, revision with another internal fixation is an alternative option. If the femoral head can be preserved as much as possible to avoid eventual joint replacement while the internal fixation failure is solved, the quality of life of patients will be significantly improved.
This current case describes a successful clinical use of a salvage procedure that allows the surgeon to avoid joint arthroplasty using INTERTAN to solve internal fixation failure caused by cut-through of Proximal Femoral Nail Antirotation-II (PFNA-II). Four years after closed reduction and internal fixation of the right femur, the patient had immobilizing right hip pain and mobility disorder. X-ray examination revealed contraction of the neck of the right femur and cut-through of the helical blade of the PFNA-II. After the revision operation, he recovered well and presented no grown pain or discomfort in weight-bearing. Conventional radiographs at 1-year follow-up showed a healed fracture, with no implant migration.
Main nail exchange and revision with INTERTAN can be considered a salvage procedure in selected cases to revise a failed fixation with PFNA, which solves internal fixation failure as well as preserves the femoral head.
在股骨转子间骨折手术治疗后，髓内钉切割穿出仍是导致髓内钉失败和患者发病的常见原因。对于不适合转换为全髋关节置换术的患者，这可能涉及较长的手术时间和大量失血，以及术后更高的假体周围骨折和脱位风险，因此另一种内固定物的翻修是一种替代选择。如果能尽可能多地保留股骨头，以避免最终的关节置换，同时解决内固定失败的问题，患者的生活质量将得到显著提高。
本案例成功地应用了一种挽救性手术，该手术允许外科医生使用 INTERTAN 来避免关节置换，以解决由近端股骨防旋髓内钉-II（PFNA-II）的螺旋刀片切割穿出引起的内固定失败。在闭合复位和右股骨内固定术后 4 年，患者出现右髋关节疼痛和活动障碍。X 线检查显示右股骨颈收缩和 PFNA-II 的螺旋刀片穿出。翻修手术后，患者恢复良好，无负重生长疼痛或不适。1 年随访时的常规 X 线片显示骨折愈合，无植入物迁移。
在选择的病例中，主钉更换和 INTERTAN 翻修可被视为一种挽救性手术，可用于修正 PFNA 固定失败，解决内固定失败问题并保留股骨头。
