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Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report

BACKGROUND: Implant cut‐out or cut‐through remains a common cause of cephalomedullary nail failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. In patients not suitable for conversion to total hip arthroplasty, which can involve long operation times and su...

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Autores principales: Zhang, Hengyan, Mu, Xuemeng, Zhang, Jia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons Australia, Ltd 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977584/
https://www.ncbi.nlm.nih.gov/pubmed/36710303
http://dx.doi.org/10.1111/os.13656
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author Zhang, Hengyan
Mu, Xuemeng
Zhang, Jia
author_facet Zhang, Hengyan
Mu, Xuemeng
Zhang, Jia
author_sort Zhang, Hengyan
collection PubMed
description BACKGROUND: Implant cut‐out or cut‐through remains a common cause of cephalomedullary nail failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. In patients not suitable for conversion to total hip arthroplasty, which can involve long operation times and substantial blood loss, as well as a higher risk of periprosthetic fracture and dislocation postoperatively, revision with another internal fixation is an alternative option. If the femoral head can be preserved as much as possible to avoid eventual joint replacement while the internal fixation failure is solved, the quality of life of patients will be significantly improved. CASE PRESENTATION: This current case describes a successful clinical use of a salvage procedure that allows the surgeon to avoid joint arthroplasty using INTERTAN to solve internal fixation failure caused by cut‐through of Proximal Femoral Nail Antirotation‐II (PFNA‐II). Four years after closed reduction and internal fixation of the right femur, the patient had immobilizing right hip pain and mobility disorder. X‐ray examination revealed contraction of the neck of the right femur and cut‐through of the helical blade of the PFNA‐II. After the revision operation, he recovered well and presented no grown pain or discomfort in weight‐bearing. Conventional radiographs at 1‐year follow‐up showed a healed fracture, with no implant migration. CONCLUSION: Main nail exchange and revision with INTERTAN can be considered a salvage procedure in selected cases to revise a failed fixation with PFNA, which solves internal fixation failure as well as preserves the femoral head.
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spelling pubmed-99775842023-03-02 Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report Zhang, Hengyan Mu, Xuemeng Zhang, Jia Orthop Surg Case Report BACKGROUND: Implant cut‐out or cut‐through remains a common cause of cephalomedullary nail failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. In patients not suitable for conversion to total hip arthroplasty, which can involve long operation times and substantial blood loss, as well as a higher risk of periprosthetic fracture and dislocation postoperatively, revision with another internal fixation is an alternative option. If the femoral head can be preserved as much as possible to avoid eventual joint replacement while the internal fixation failure is solved, the quality of life of patients will be significantly improved. CASE PRESENTATION: This current case describes a successful clinical use of a salvage procedure that allows the surgeon to avoid joint arthroplasty using INTERTAN to solve internal fixation failure caused by cut‐through of Proximal Femoral Nail Antirotation‐II (PFNA‐II). Four years after closed reduction and internal fixation of the right femur, the patient had immobilizing right hip pain and mobility disorder. X‐ray examination revealed contraction of the neck of the right femur and cut‐through of the helical blade of the PFNA‐II. After the revision operation, he recovered well and presented no grown pain or discomfort in weight‐bearing. Conventional radiographs at 1‐year follow‐up showed a healed fracture, with no implant migration. CONCLUSION: Main nail exchange and revision with INTERTAN can be considered a salvage procedure in selected cases to revise a failed fixation with PFNA, which solves internal fixation failure as well as preserves the femoral head. John Wiley & Sons Australia, Ltd 2023-01-29 /pmc/articles/PMC9977584/ /pubmed/36710303 http://dx.doi.org/10.1111/os.13656 Text en © 2023 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Case Report
Zhang, Hengyan
Mu, Xuemeng
Zhang, Jia
Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report
title Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report
title_full Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report
title_fullStr Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report
title_full_unstemmed Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report
title_short Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report
title_sort successful revision with intertan for a blade cut through in pfna fixation: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977584/
https://www.ncbi.nlm.nih.gov/pubmed/36710303
http://dx.doi.org/10.1111/os.13656
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