大腿骨頚部骨折後に生じた大腿骨遠位部骨折の治療経験

概要

論文の詳細を見る
Ipsilateral distal femoral fracture after postoperative femoral neck fracture is a rare complication and treatment is often difficult. We treated three cases in which retrograde supracondylar intramedullary nails were used for internal fixation. The patients consisted of three females with ages ranging from 75 to 89. Two patients underwent hemiarthroplasty and another underwent Gamma nailing. According to AO classification, they were classified into A1 (2 cases) and C1 (1 case), respectively. All patients tended to fall down easily after postoperative femoral neck fracture.Consequently all fractures healed within four months. The average knee range of motion was —10 to 93 degrees. Clinical results were evaluated according to Neer's criteria. All cases were ranked as unsatisfactory. In generally, walking ability tended to deteriorate because multiple fractures occurred ipsilatelly. One case developed secondary femoral fracture at the mid shaft postoperatively, because of jamming between the distal tip of the cement and proximal tip of the intramedullay nail.Use of retrograde supracondylar intramedullary nail is effective for this type of fracture, but we have to be careful about the length of the intramedullary nail before surgical planning. As rigid fixation is difficult for the osteoporotic bone, post operative treatment is also important.
西日本整形・災害外科学会の論文