A rare complication of pelvic perforation by an excessive medial slide of the helical blade after treatment of an intertrochanteric fracture with proximal femoral nail anti-rotation: A case report and literature review

• 作者: Chen Xiao-Kun Xiong Jian Liu Yi-Jun Han Quan Wang Tian-Bing Zhang Dian-Ying
• 来源期刊: 中华创伤杂志英文版
• 关键词: Hip fractures Intertrochanteric fractures Proximal femoral nail anti-rotation Complication Pelvic perforation Case report
• 年，卷（期）: 2022,（2）
• 所属期刊栏目: Case Report
• 页码范围: 118-121
• 页数: 4页
• 语种: 中文
• DOI: 10.1016/j.cjtee.2021.08.007

摘要

Intertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intramedullary fixation device for unstable intertrochanteric fractures. Pelvic perforation by cephalic screw is a rare complication. We reported an 84-year-old female who fell at home and sustained an intertrochanteric fracture. The patient underwent surgery with PFNA as the intramedullary fixation device. Routine postoperative examination revealed medial migration of the helical blade that eventually caused pelvic perforation. We performed a cemented total hip arthroplasty as the savage procedure. At the latest follow-up of 12 months after total hip arthroplasty, the patient had no pain or loosening of the prosthesis in the left hip. Pelvic perforation should be considered when choosing PFNA as the intramedullary fixation device, especially in patients with severe osteoporosis wherein the helical blade can be easily inserted during the operation. The lack of devices to avoid oversliding of the helical blade in PFNA is an unreported cause of this complication and should be considered in such cases.