旋入式自锁髓内钉在股骨骨折中的应用

目的探索旋入式自锁髓内钉在股骨骨折中的应用效果。方法对57例不同类型的股骨骨折采用旋入式自锁髓内钉内固定。结果随访8周~3年,57例中,优38例,良17例,可2例,优良率96·5?。膝关节功能全部恢复,无畸形愈合及断钉。结论旋入式自锁髓内钉在股骨骨折固定中具有切口小、创伤小、操作方便、固定牢固、愈合快、取出简便等优点,临床应用疗效确切。     

Epidemiology of diaphyseal femoral fracture

The incidence of diaphyseal femoral fracture in adults, aged 20 years and older, was determined in Stockholm County using hospital admission rates. The validity of the data was investigated by a study of the medical records of a sample of 277 cases and also by determining the incidence in a subpopulation of 139 cases using an alternative method. The incidence decreased from age 20 to middle age after which it increased into old age. The age-related increase was more pronounced in women and in fractures caused by moderate trauma. From 1972 to 1981, the incidence of diaphyseal femoral fracture caused by moderate trauma increased annually by 10 per cent in women aged 75 years and older.     

Epidemiology of diaphyseal femoral fracture

The incidence of diaphyseal femoral fracture in adults, aged 20 years and older, was determined in Stockholm County using hospital admission rates. The validity of the data was investigated by a study of the medical records of a sample of 277 cases and also by determining the incidence in a subpopulation of 139 cases using an alternative method. The incidence decreased from age 20 to middle age after which it increased into old age. The age-related increase was more pronounced in women and in fractures caused by moderate trauma. From 1972 to 1981, the incidence of diaphyseal femoral fracture caused by moderate trauma increased annually by 10 per cent in women aged 75 years and older.     

Epidemiology of diaphyseal femoral fracture

The incidence of diaphyseal femoral fracture in adults, aged 20 years and older, was determined in Stockholm County using hospital admission rates. The validity of the data was investigated by a study of the medical records of a sample of 277 cases and also by determining the incidence in a subpopulation of 139 cases using an alternative method. The incidence decreased from age 20 to middle age after which it increased into old age. The age-related increase was more pronounced in women and in fractures caused by moderate trauma. From 1972 to 1981, the incidence of diaphyseal femoral fracture caused by moderate trauma increased annually by 10 per cent in women aged 75 years and older.     

Neglected femoral diaphyseal fracture

Femoral diaphyseal fractures usually result after trauma of high magnitude and because of this, can be life-threatening injuries or may result in considerable physical disability if not treated with care and caution. Nonoperative treatment of these fractures continues to be popular among the patient population in the Indian subcontinent, which in majority of cases, leads to healing in malalignment, shortening of the limb, chondromalacia patellae, and loss of knee motion. Although the majority of these fractures are being treated by operative methods today, success of the treatment depends largely on the surgeon's familiarity with the procedure or the type of fracture pattern (comminuted or segmental) particularly in a polytraumatized patient. Delayed union and nonunion of femoral-diaphyseal fractures and implant failures usually result after these procedures or the type of injury. The purpose of this study is to discuss various types of neglected femoral diaphyseal fractures and to review the literature on their treatment.     

TKA after clamshell osteotomy for femoral diaphyseal malunion

Proper component positioning is essential for successful total knee arthroplasty (TKA). Femoral component positioning presents a technical challenge when significant femoral deformity is present. Most commonly, an intramedullary guide is used to make an accurate distal femoral cut. However, in the presence of a significant femoral deformity, this is not a viable option.The use of clamshell osteotomy to restore anatomic alignment in patients with complex femoral diaphyseal deformity is described in the literature. This article describes a case of a patient who underwent staged TKA after clamshell osteotomy and retrograde femoral nailing to correct femoral diaphyseal malunion. The retrograde intramedullary nail was retained and used as an intramedullary guide, allowing for TKA in a routine manner. Using an intramedullary nail as an alignment guide may be more accurate than using extramedullary alignment and may avoid the increased surgical time and potential pin-site stress risers of navigation. It is a simple, effective way to treat complicated diaphyseal femoral deformities in the face of posttraumatic knee arthritis. Further study of this technique with longer follow-up and multiple surgeons is necessary to validate this treatment algorithm.     

加长版PFNA治疗股骨转子间骨折合并股骨干骨折的临床疗效研究

【摘要】 目的 研究重建钉和加长型PFNA用于股骨转子间骨折合并股骨干骨折治疗的临床疗效研究。方法 选取2012年1月~2014年6月到我院就诊并住院治疗的股骨转子间骨折合并骨干骨折的患者共60例为研究对象,分为两组: 为重建钉组和加长组,分别采用重建钉和加长型PFNA进行治疗,比较两组患者手术时间、术中出血量、骨折愈合时间、伤口长度、并发症、Harris评分、Lyshonlm评分。结果〓加长组的术中出血量、伤口长度均高于重建钉组(P<0.05),加长组的股骨转子间骨折的愈合时间和股骨干骨折的愈合时间也短于重建钉组(P<0.05),但两组手术时间差异无统计学意义。所有患者中只有一例发生切口感染,无其他严重并发症发生。加长组的Harris评分在术后各时间点均高于重建钉组,而Lyshonlm评分从术后第二个月开始之后的各时间点均低于重建钉组(P<0.05),但术后两周两组的Lyshonlm评分差异无统计学意义。结论 加长型PFNA用于股骨转子间骨折合并股骨干骨折治疗的临床疗效较好,患者恢复更快。     

Ipsilateral diaphyseal femur fracture after resection arthroplasty

Resection arthroplasty of the hip is most commonly used for recalcitrant infections in the setting of prior hemiarthroplasty and total hip arthroplasty. Reported complications of this procedure include shortening of the extremity and ambulation difficulties requiring assistive devices. We report a case of an unusual finding of an ipsilateral femoral shaft fracture after a ground level fall 4 months after a resection arthroplasty for a septic hip. A closed reduction with internal fixation using an intramedullary nail was performed, and 3 months postoperatively, the patient was ambulating with device assistance.     

Knee laxity associated with a proximal diaphyseal tibial and fibular fracture

If operative treatment of a proximal diaphyseal tibial and fibular fracture is required, in most cases, it involves reduction and stabilization of only the tibial fracture. In this case report, after stabilization of the tibial fracture with an intramedullary nail, the patient continued to demonstrate significant varus knee laxity, despite an intact proximal tibiofibular joint and undisplaced fibular head. The stability of the knee was achieved only with internal fixation of the segmental fibular fracture. This case shows the importance of assessing knee laxity in all cases of proximal tibial and fibular fractures.     

可吸收髓内针在四肢长骨干骨折中的应用

目的观察可吸收髓内针在四肢长骨干骨折中应用的疗效。方法23例四肢长骨干骨折应用可吸收髓内针内固定。其中,胫骨干骨折18例,肱骨干骨折5例;胫骨骨折中粉碎性骨折8例。结果随访8~31个月。术后切口均Ⅰ期愈合,无切口感染及肿胀积液,无骨髓炎、畸形愈合及骨不连接发生,无毒性反应及副作用,患肢功能良好。结论可吸收髓内针是治疗四肢长骨干骨折较理想的一种内固定方法。     

TRIGEN股骨髓内钉在股骨骨折中的应用

目的探讨TRIGEN股骨髓内钉在股骨骨折中的应用效果。方法对54例股骨骨折患者采用TRIGEN股骨髓内钉治疗,记录髓内钉远端锁钉时间、透视次数、一次锁钉成功率及骨折愈合时间。结果54例均获得随访,时间8~36个月。患者骨折均愈合,愈合时间3~14个月。均无伤口感染、血管神经损伤。Sureshot远端瞄准系统远端锁钉时间为142~412 s,一次锁钉成功率为97.2%,透视次数为1~6次。结论TRIGEN股骨髓内钉治疗股骨骨折治疗效果满意,具有损伤小、固定简便、并发症少等优点;Sureshot远端瞄准系统一次锁钉准确率高、操作时间短、放射量小。     

Comparative study of the proximal femoral nail antirotation versus the reconstruction nail in the treatment of comminuted proximal femoral fracture

The purpose of our study was to compare the proximal femoral nail antirotation (PFNA; Synthes, Paoli, Pennsylvania) with a reconstruction nail (Recon; Zimmer, Warsaw, Indiana) in the treatment of comminuted proximal femoral fractures. Between 2003 and 2010, twenty-three consecutive patients with AO/Orthopaedic Trauma Association 31-A3 fractures combined with proximal 32 fractures who had a minimum 18-month follow-up were evaluated retrospectively. There were 10 patients (age range, 18-74 years) in the Recon nail group and 13 patients (age range, 22-90 years) in the PFNA nail group. Patients treated with Recon nails experienced a longer operation time (P=.006) and more blood loss (P=.012) than patients treated with the PFNA nail. On postoperative radiographs, the change in the neck-shaft angle was 8.8° in the Recon nail group and 4.7° in the PFNA nail group (P=.048). The fracture union time averaged 31.8 weeks in the Recon nail group and 21.5 weeks in the PFNA nail group (P=.148). More patients in the Recon nail group underwent major or minor reoperation (P=.038) compared with the PFNA nail group. No implant failure occurred in either group. The functional results were similar in the 2 groups. For the treatment of comminuted proximal femoral fractures, use of either the PFNA and Recon nail is clinically effective. However, the PFNA nail provides a shorter operation time, less blood loss, and better realignment ability and reduces the incidence of reoperation. Therefore, the PFNA nail can be considered a better device than the Recon nail.     

Delayed femoral shaft fracture secondary to nail gun injury: a case report

Nail gun injuries are common workplace occurrences among construction workers; however, delayed fractures of the femur after a nail gun injury are not found in the medical literature. We report the case of a patient who presented with such a fracture 3 days after accidentally firing a nail into his thigh. The patient was taken to the operating room for intramedullary nailing, irrigation and debridement, and antibiotic beads. Standard postoperative hospital care was provided, and after 2 days of intravenous antibiotics, the patient was returned to the operating room for removal of the antibiotic beads and a delayed primary closure. At the most recent follow-up, over 1 year postinjury, he had radiographic healing and was asymptomatic. Although it is difficult to predict whether the stress riser created by a nail gun injury will lead to a fracture, weight-bearing status and the aggressiveness of treatment to prevent infection are factors that need to be carefully considered in patients with this type of injury.     

闭合复位或有限切开复位交锁髓内钉治疗肱骨干骨折

目的探讨交锁髓内钉治疗肱骨干骨折的疗效。方法采用闭合复位或有限切开复位交锁髓内钉治疗肱骨干骨折43例。结果43例均获随访,时间8-18个月。40例骨折愈合;3例延迟愈合,行锁钉动力化后骨折愈合。骨折愈合时间10-32周。疗效参照Neer评分标准进行评价：优27例,良12例,可4例,优良率90.7%。结论交锁髓内钉固定牢靠,对骨折端血运影响小,是治疗肱骨干骨折较为理想的方法。     

Use of Huckstep nail in the periimplant femoral shaft fracture

87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations.     

Mechanical properties of different combinations of flexible nails in a model of a pediatric femoral fracture

Flexible nailing of pediatric femoral shaft fractures is based on the principle of using two C-shaped nails to create six points of fixation. However, clinical studies using various nail combinations demonstrate similar outcomes. This study aimed to compare the mechanical properties of different nail combinations by testing them in a model of a child's midshaft femoral fracture. The two C-shaped nails were compared with two straight nails and with paired S- and C-shaped nails. The constructs were tested in four-point bending and torsion. Graphs of the data were produced, from which the bending and torsional stiffness of the constructs was calculated. The results showed that there was no significant difference between the mechanical properties of the three different constructs. The conclusion is that any of the tested nail combinations can be used to treat a midshaft fracture of the femur in a child.     

Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation

Objective： Subtrochanteric femoral fractures are severe injuries. Although many treatment methods have been developed, controversy exists regarding the optimal management of these fractures. This study evaluated the clinical outcome of subtrochanteric femoral fractures fixed with long proximal femoral nail antirotation （PFNA-Iong）. Methods： Between October 2006 and February 2008, 25 patients with traumatic subtrochanteric fractures of the femur were treated with PFNA-long. Closed reduction and fixation were performed in 20 cases. In the remaining 5 cases, closed reduction was difficult, so limited open reduction was performed, with bone grafting in 4 cases and circumfer-ential wiring in 4 cases. Results： The average follow-up time was 16.1 months. All subtrochanteric femoral fractures healed uneventfully except one case of delayed union. The mean union time was 26.2 weeks. Technical difficulties with nail insertion were encountered in 3 cases. No implant failure was observed. Conclusion： PFNA-long is effective in treatment of subtrochanteric femoral fractures, with a high rate of bone union, minor soft tissue damage, early return to functional exercise and few implant-related complications.     

Surgical factors contributing to nonunion in femoral shaft fracture followingintramedullary nailing

Purpose: To explore the possible surgical factors related with nonunion in femoral shaft fracture following intramedullary nailing. Methods: We retrospectively analyzed totally 425 patients with femoral shaft fracture in level I urban trauma center, including 254 males and 171 females, with an average age of 37.6 (ranging from 21 to 56) years old. The inclusion criteria included: (1) traumatically closed fracture of femoral shaft, with preoperative films showing non-comminuted fracture, such as transverse fracture, oblique fracture or spiral fracture; (2) closed reduction and fixation with interlocking intramedullary nail at 3e7 days after trauma; (3) complete follow-up data available. The relationship between the following factors (fracture site, reduction degree, direction of nail insertion and nail size) and nonunion was studied. Results: The incidence of femoral nonunion was 2.8% in patients with closed simple fracture undergoing interlocking intrameduallary nailing, including 11 cases of hypertrophic nonunion. Nonunion was related significantly to distal fracture, unsatisfactory reduction and unreamed nail (p<0.05). There was no significant difference between antegrade nail and retrograde nail (p>0.05). Conclusions: Nonunion in femoral shaft facture following interlocking intramedullary nailing is related to fracture site, fracture reduction and nail diameter. The choice of reamed nails or unreamed nails depends on the fracture site and reduction degree.     

Intramedullary nailing of pediatric femoral shaft fracture

Intramedullary nail fixation of pediatric long bone fracture, particularly femoral shaft fracture, has revolutionized the care and outcome of these complex injuries. Nailing is associated with a high rate of union and a low rate of complications. Improved understanding of proximal femoral vascularity has led to changes in nail insertion methodology. Multiple fixation devices are available; selection is based on fracture type, patient age, skeletal maturity, and body mass index. A thorough knowledge of anatomy and biomechanics is required to achieve optimal results without negatively affecting skeletal development.     

带锁髓内钉治疗股骨、胫骨骨折

目的 探讨带锁髓内钉治疗股骨、胫骨骨折的方法和疗效。方法 以带锁髓内钉开放复位静力型内固定手术方式治疗股骨、胫骨骨折共26例。结果 经平均半年的随访,所有病例骨折全部愈合,关节功能良好,无钉折弯、断裂等并发症发生。结论 用带锁髓内钉治疗股骨、胫骨骨折具有稳定性高、疗效确切和并发症少等优点,是一种理想的治疗方法。