Lack Benjamin T, Childers Justin T, Hennekens Charles H, Courtney Jonathan B
Department of Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Department of Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Cureus. 2024 Dec 10;16(12):e75485. doi: 10.7759/cureus.75485. eCollection 2024 Dec.
Subtrochanteric fractures in older patients are typically due to low-energy falls. The standard of care is intramedullary nailing. The Smith & Nephew Trigen Intertan (Memphis, TN, US) is an intramedullary nail with a novel design that incorporates two integrated compression screws. We present a case of intramedullary nail failure in a patient with a subtrochanteric fracture. A 62-year-old woman with osteoporosis, a 40-year history of smoking, and consumption of two to three alcoholic beverages daily, weighing 177 pounds and five feet two inches tall (BMI 32.4), experienced a low-energy fall in her home. She presented to the emergency department (ED) with a shortened and externally rotated right leg with pain on manipulation. Her neurovasculature was intact. An X-ray revealed a comminuted, right subtrochanteric femur fracture. The patient underwent open reduction and internal fixation with a Trigen Intertan nail with no intraoperative complications. Her leg returned to pre-injury length, and she resumed ambulating at her pre-injury level. Six weeks later, the patient experienced pain upon standing. She was transported to the ED by ambulance where she presented with a shortened externally rotated right leg with pain on manipulation. An X-ray revealed failure of the intramedullary nail with breakage at the lag screw hole. Her care was transferred to another orthopedic surgeon (JC), where she underwent hardware removal and conversion to a total hip arthroplasty. Postoperatively, her legs were of equal length, and her neurovasculature remained intact. Four months later, at her final follow-up, she was ambulating unassisted at her pre-fracture level. Subtrochanteric fractures in elderly patients pose serious threats to morbidity, mortality, and quality of life. Surgery with intramedullary nail placement and rapid ambulation have generally favorable outcomes. Failure rates are generally very low. Such circumstances generally require hardware removal and total hip arthroplasty, which are generally curative but can confer small risks of morbidity and mortality.
老年患者的转子下骨折通常由低能量跌倒所致。治疗的标准方法是髓内钉固定。史赛克Trigen Intertan髓内钉（美国田纳西州孟菲斯市）是一种设计新颖的髓内钉，其包含两个一体化加压螺钉。我们报告一例转子下骨折患者髓内钉固定失败的病例。一名62岁女性，患有骨质疏松症，有40年吸烟史，每天饮用两到三杯酒精饮料，体重177磅，身高5英尺2英寸（体重指数32.4），在家中发生低能量跌倒。她因右下肢缩短、外旋且手法检查时有疼痛而就诊于急诊科。其神经血管系统完好。X线检查显示右侧转子下股骨粉碎性骨折。患者接受了Trigen Intertan髓内钉切开复位内固定术，术中无并发症。她的腿部恢复到受伤前长度，并恢复到受伤前的活动水平。六周后，患者站立时出现疼痛。她被救护车送往急诊科，检查发现右下肢缩短、外旋，手法检查时有疼痛。X线检查显示髓内钉固定失败，拉力螺钉孔处断裂。她的治疗转由另一位骨科医生（JC）负责，在那里她接受了内固定取出术并改行全髋关节置换术。术后，她的双下肢等长，神经血管系统仍然完好。四个月后，在最后一次随访时，她无需辅助即可恢复到骨折前的活动水平。老年患者的转子下骨折对发病率、死亡率和生活质量构成严重威胁。髓内钉置入手术和快速恢复活动通常会有良好的结果。失败率通常很低。这种情况一般需要取出内固定并进行全髋关节置换术，这通常是治愈性的，但会带来较小的发病和死亡风险。
