Panchal Olivia, Schultz Matthew J, Lutz Rex W, Smith Eric B, Deirmengian Gregory K
Orthopaedic Surgery, Texas College of Osteopathic Medicine, Fort Worth, USA.
Orthopeadic Surgery, Jefferson Health New Jersey, Stratford, USA.
Cureus. 2023 Apr 3;15(4):e37075. doi: 10.7759/cureus.37075. eCollection 2023 Apr.
In patients who undergo femoral fracture fixation with a cephalomedullary nail, the breakage of one or more of the distal interlocking screws is a well-described phenomenon. The presence of a broken interlocking screw in patients who require the removal of their cephalomedullary nail presents a unique challenge. The broken interlocking screw may be retrieved, or the screw may be retained if it is not engaged within the nail and the nail can safely be removed while leaving the broken screw fragment behind. We report a hip conversion arthroplasty case with a broken interlocking screw where the nail was removed with ease and the broken screw was assumed to have been left behind. Cerclage wires were placed for an apparent proximal femoral fracture. Postoperative X-rays demonstrated a large lucency tracking from the prior location of the distal interlocking screw to the calcar region. This finding made it evident that the broken screw had been retained in the nail and was dragged up the femur upon nail removal, causing a large gouge spanning the entire femur.
在接受髓内钉固定股骨骨折的患者中，一枚或多枚远端交锁螺钉断裂是一种已被充分描述的现象。对于需要取出髓内钉的患者，出现断裂的交锁螺钉会带来独特的挑战。断裂的交锁螺钉可以取出，如果它未嵌入髓内钉且能在留下断裂螺钉碎片的情况下安全取出髓内钉，则螺钉也可以保留。我们报告一例髋部转换关节成形术病例，该病例有一枚断裂的交锁螺钉，髓内钉轻松取出，且假定断裂螺钉留在了体内。因明显的股骨近端骨折放置了环扎钢丝。术后X线片显示从远端交锁螺钉先前位置到股骨距区域有一大片透亮区。这一发现表明断裂螺钉留在了髓内钉中，并在取出髓内钉时被向上拖至股骨，导致整个股骨出现一大条沟槽。
