Kim Baegyun, Lee Ji Won, Yoon Euisun, Lee Sungho
Department of Orthopaedic and Trauma Surgery, Cheju Halla General Hospital, Jeju, Republic of Korea.
Trauma Case Rep. 2024 Jun 14;53:101063. doi: 10.1016/j.tcr.2024.101063. eCollection 2024 Oct.
We present a case report on the management and outcome of a periprosthetic tibial shaft fracture treated with intramedullary nailing. The patient, a 78-year-old female, presented with a history of having undergone total knee arthroplasty ten years ago due to osteoarthritis. She sustained a periprosthetic fracture of the tibial shaft with compromised soft tissues surrounding the fracture site following a motor vehicle accident. Plain radiographs revealed a displaced tibial shaft fracture with a flipped large spiral wedge fragment located distal to the total knee prosthesis. Due to the poor soft tissue condition and the risk of complications in wound healing, as well as the desire to avoid prolonged bed rest and immobilization, intramedullary nailing was chosen as the primary treatment modality. Despite the challenging circumstances, the patient achieved satisfactory healing and recovered her pre-injury ambulation status with no significant complications at the six-month follow-up.
Managing periprosthetic tibial shaft fractures in the presence of compromised soft tissues presents significant challenges for orthopedic surgeons. In this case, intramedullary nailing proved to be a suitable treatment option, minimizing soft tissue trauma and providing stable fixation to facilitate early mobilization and weight bearing.
我们报告一例采用髓内钉治疗的假体周围胫骨干骨折的治疗情况及结果。患者为一名78岁女性，有10年前因骨关节炎接受全膝关节置换术的病史。她在一次机动车事故后发生了假体周围胫骨干骨折，骨折部位周围软组织受损。X线平片显示胫骨干骨折移位，有一个翻转的大螺旋楔形骨折块位于全膝关节假体远端。由于软组织条件差、伤口愈合有并发症风险，以及希望避免长期卧床和固定，髓内钉被选为主要治疗方式。尽管情况具有挑战性，但患者在六个月随访时实现了满意的愈合，并恢复到受伤前的行走状态，无明显并发症。
在软组织受损的情况下处理假体周围胫骨干骨折对骨科医生来说是重大挑战。在本病例中，髓内钉被证明是一种合适的治疗选择，可将软组织创伤降至最低，并提供稳定固定以促进早期活动和负重。
