Tseng Han-Po, Chien Chi-Sheng, Wu Tsung-Mu
Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
Department of Orthopedic Surgery, Chi-Mei Medical Center, Tainan, Taiwan.
Acta Orthop Traumatol Turc. 2025 Jun 5;59(4):232-236. doi: 10.5152/j.aott.2025.24213.
The management of retained orthopedic hardware during amputation procedures presents significant challenges. A case utilizing a modified Gritti-Stokes through-knee amputation to address a periprosthetic fracture with an exposed intramedullary nail (IMN) in a patient with multiple comorbidities is reported. A 47-year-old male with a history of human immunodeficiency virus, hepatitis C virus, and type 2 diabetes mellitus presented with a left femoral periprosthetic supracondylar fracture. The patient had an existing IMN from a previous femoral shaft fracture 20 years prior, along with a left below-knee amputation. Due to the newly occurred periprosthetic fracture and the patient's immunocompromised status, further amputation was deemed necessary. However, removal of the well-integrated IMN posed significant risks. A modified Gritti-Stokes through-knee amputation was performed, adapting the procedure to use the patella as a biological cap to cover the exposed IMN tip. At 4-month follow-up, the patient demonstrated satisfactory wound healing and stable positioning of the patellar cap. The patient achieved ambulation with an above-knee prosthesis and crutch assistance, reporting high satisfaction and no pain or discomfort. This case highlights the versatility of the Gritti-Stokes procedure in addressing complex scenarios involving retained hardware. By utilizing the patella as a biological cover for the exposed IMN, the risks associated with hardware removal was avoided while achieving a stable, well-healed amputation stump. This modification of the Gritti-Stokes technique offers a viable solution for patients with retained IMNs requiring through-knee amputation, particularly in cases where hardware removal is contraindicated or highly risky.
截肢手术中保留的骨科植入物的处理面临重大挑战。本文报告了一例病例，该病例采用改良的格里蒂-斯托克斯经膝关节截肢术，以处理一名患有多种合并症的患者的假体周围骨折伴髓内钉（IMN）外露的情况。一名47岁男性，有人类免疫缺陷病毒、丙型肝炎病毒感染史及2型糖尿病，出现左股骨假体周围髁上骨折。该患者20年前因股骨干骨折曾植入一枚IMN，同时行左膝下截肢术。由于新发生的假体周围骨折以及患者的免疫功能低下状态，认为有必要进一步截肢。然而，取出融合良好的IMN存在重大风险。于是进行了改良的格里蒂-斯托克斯经膝关节截肢术，调整手术方式，利用髌骨作为生物帽覆盖外露的IMN尖端。在4个月的随访中，患者伤口愈合良好，髌骨帽位置稳定。患者借助膝上假肢和拐杖辅助实现了行走，报告满意度高，无疼痛或不适。该病例突出了格里蒂-斯托克斯手术在处理涉及保留植入物的复杂情况时的多功能性。通过将髌骨用作外露IMN的生物覆盖物，在实现稳定、愈合良好的截肢残端的同时，避免了与取出植入物相关的风险。格里蒂-斯托克斯技术的这种改良为需要经膝关节截肢的保留IMN的患者提供了一种可行的解决方案，特别是在植入物取出禁忌或风险很高的情况下。
