Heck Benjamin E, Poucke Logan Van, Heck Vanessa C, Heck Bruce E
Department of Medicine and Life Sciences, College of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA.
Department of Medicine, College of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA.
J Orthop Case Rep. 2024 May;14(5):22-27. doi: 10.13107/jocr.2024.v14.i05.4420.
The double squeeze technique for fracture stabilization is a technique in which the surgeon uses a second reduction clamp to hold and stabilize a smaller reduction clamp that reduces a fracture or plate yet is too small to hold by itself. This technique greatly assists anatomic fracture reduction and stabilization and allows the surgeon to complete the operation when there is limited reduction instrumentation available, or the surgeon needs more excursion on a small clamp holding a fracture and does not want to change instruments and possibly lose a reduction. We present a case of the double squeeze clamp technique, which to our knowledge has not been reported, to facilitate limited open reduction percutaneous plate stabilization in a distal tibia fracture.
This case report presents an 18-year-old male with a closed, oblique, displaced right distal tibia fracture following a crush injury to the extremity with a tree while using a chainsaw. He was initially seen in the emergency room and was discharged home in a splint to follow-up with the orthopedic surgeon on call. The family requested follow-up with our practice 3 days later and requested surgery at their rural local hospital secondary to insurance reasons. Patient requested plate fixation to treat his fracture. Due to limited reduction instrumentation in the facility, a double squeeze reduction clamp technique using a pointed reduction clamp on a serrated reduction clamp that was too small to hold the plate on the reduced fracture accomplished stabilization of the plate on the fracture while screws were placed.
The double squeeze reduction clamp technique using one reduction clamp on a smaller reduction clamp greatly increases the ability to successfully reduce and stabilize multiple variations of different fractures whether secondary to differences in sizes of the bones, different types of bones, or in our case limited fracture reduction tools available.
骨折固定的双挤压技术是一种外科医生使用第二个复位钳来固定和稳定较小复位钳的技术,该较小复位钳用于复位骨折或钢板,但自身太小无法单独固定。这项技术极大地有助于骨折的解剖复位和固定,并且当可用的复位器械有限时,或者外科医生在固定骨折的小夹子上需要更大的活动范围且不想更换器械并可能失去复位效果时,能让外科医生完成手术。我们报告一例双挤压钳技术的病例,据我们所知该病例尚未被报道,该技术有助于在胫骨远端骨折中进行有限切开复位经皮钢板固定。
本病例报告介绍了一名18岁男性,其在使用电锯时下肢被树挤压,导致右侧胫骨远端闭合性、斜形、移位骨折。他最初在急诊室就诊,之后戴着夹板出院,以便与随叫随到的骨科医生进行随访。三天后,患者家属因保险原因要求到我们科室进行随访,并在其当地农村医院要求手术。患者要求采用钢板固定治疗其骨折。由于该医院的复位器械有限,在一个锯齿状复位钳上使用一个尖嘴复位钳进行双挤压复位钳技术,该锯齿状复位钳太小无法在骨折复位后固定钢板,在放置螺钉时实现了钢板在骨折处的固定。
在较小的复位钳上使用一个复位钳的双挤压复位钳技术极大地提高了成功复位和固定多种不同类型骨折的能力,无论是由于骨骼大小差异、骨骼类型不同,还是在我们的病例中可用的骨折复位工具有限。