Jabczenski F F, Crawford M
Lovelace Medical Center, Albuquerque, New Mexico, USA.
J Arthroplasty. 1995 Feb;10(1):95-101. doi: 10.1016/s0883-5403(05)80108-1.
Four supracondylar fractures of the femur in three patients with total knee arthroplasties were treated by retrograde intramedullary nailing using an interlocking renamed nail (GSH Nail, Smith and Nephew Richards, Memphis, TN) specifically designed for fractures of the distal femur. Three cases were acute fractures and one was a refracture through a screw hole of a previously plated supracondylar fracture. All fractures healed and there were no complications. The procedure is performed by closed nailing using fluoroscopic guidance with the nail placed through the intercondylar notch of the femoral prosthesis and interlocking to the fracture fragments with a percutaneous targeting device. The advantages are that the procedure is performed by closed techniques that preserve the fracture hematoma and reduce operative blood loss, the fracture is stabilized by a load-sharing nail, and immediate motion with limited weight bearing is possible.
3例全膝关节置换术后患者发生4例股骨髁上骨折，采用逆行髓内钉固定治疗，使用专门为股骨远端骨折设计的带锁可改名髓内钉（GSH钉，施乐辉公司，田纳西州孟菲斯）。3例为急性骨折，1例为既往钢板固定的髁上骨折通过螺钉孔处的再骨折。所有骨折均愈合，无并发症发生。该手术在透视引导下采用闭合穿钉技术进行，髓内钉通过股骨假体的髁间切迹置入，并使用经皮瞄准装置与骨折块锁定。其优点在于该手术采用闭合技术，可保留骨折血肿并减少术中失血，骨折通过分担负荷的髓内钉得以稳定，且术后可立即进行有限负重的活动。
