Kumar Prasoon, Aggarwal Sameer, Gupta Ansh, Dadra Ankit, Patel Sandeep, Goni Vijay
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Orthop Case Rep. 2024 Dec;14(12):13-17. doi: 10.13107/jocr.2024.v14.i12.5000.
Delayed union, non-union, and unstable fixation can lead to fatigue fractures of orthopedic implants. Breakages typically occur at the fracture site or locking screw insertion, acting as stress concentration foci. This case report highlights a rare instance of a 3-part broken proximal femoral nail (PFN), extracted using a corticotomy-assisted method without knee joint violation.
A 45-year-old male patient with a subtrochanteric femur fracture, initially fixed with a short PFN, presented with non-union and a broken implant a year post-surgery. Radiographs revealed breakage at two sites, creating three nail pieces. During revision surgery, the proximal nail part was removed through standard extraction. The middle fragment was accessed and removed at the fracture site, and the distal part was extracted through a lateral cortical window using a beaded guidewire in a retrograde fashion, avoiding the knee joint. A long PFNA was subsequently inserted, and bone grafting was performed.
This case underscores a rare PFN failure pattern, with fractures at three sites. The corticotomy-assisted extraction technique preserved medullary canal integrity, minimized tissue damage, and maintained biomechanical stability. This approach offers a viable alternative to traditional methods, reducing complications and improving surgical outcomes.
骨折延迟愈合、不愈合以及内固定不稳定可导致骨科植入物发生疲劳性骨折。骨折通常发生在骨折部位或锁定螺钉置入处，这些部位会成为应力集中点。本病例报告重点介绍了一例罕见的三部分断裂的股骨近端髓内钉（PFN），采用皮质切开辅助方法取出，未累及膝关节。
一名45岁男性患者，转子下股骨骨折，最初采用短PFN固定，术后一年出现骨折不愈合及植入物断裂。X线片显示在两个部位发生断裂，形成三个髓内钉碎片。在翻修手术中，近端髓内钉部分通过标准方法取出。中间碎片在骨折部位找到并取出，远端部分通过外侧皮质窗口，使用带珠导丝逆行取出，避免累及膝关节。随后插入一枚加长型股骨近端防旋髓内钉（PFNA），并进行了植骨。
本病例强调了一种罕见的PFN失败模式，即三个部位发生骨折。皮质切开辅助取出技术保留了髓腔完整性，使组织损伤最小化，并维持了生物力学稳定性。这种方法为传统方法提供了一种可行的替代方案，减少了并发症，改善了手术效果。
