Abstract
Intramedullary nailing is the preferred treatment method in tibial, femoral shaft, and sub- or intertrochanteric fractures. Despite good results, a number of complications have been well-characterized. Joint perforation by bone fragment during nail insertion is one such complication.We report an eventful case of a 63-year-old female patient who presented with an intertrochanteric fracture. Osteosynthesis with a short proximal femoral nail was complicated by a well-known and recognized on-time complication - an iatrogenic fracture of the femoral shaft. However, it was further complicated by knee arthrodesis by a bone fragment when a long nail was inserted. The bone fragment not only “closed” the knee joint, but fractured the medial tibial condyle and protruded into the medial soft tissues of the joint. This misfortune was not recognized intraoperatively and led to revision surgery in the short term and joint post-traumatic arthrosis with resultant total knee replacement in the long term.
Highlights
Over the past decade, intramedullary nailing (IMN) has become the preferred treatment method in tibial, femoral shaft, and sub- or intertrochanteric fractures [1-4]
At the time of writing, a PubMed database search using the terms complication AND nail AND fragment AND bone AND joint revealed five cases: three cases of femoral bone fragment penetration to the knee joint, one case of tibial fragment penetration to the ankle joint, and one case of ankle joint perforation by bone fragment [10-12]. It is the first described case of knee joint arthrodesis and complete tibial condyle perforation by femoral bone fragment during nailing of an intertrochanteric fracture, which led to posttraumatic arthrosis and total knee arthroplasty
Careful examination of postoperative X-rays revealed a 60 x 10 mm bony fragment starting from the distal tip of the nail, going through knee joint space into the medial tibial condyle and perforating its medial cortex (Figures 3-4)
Summary
Intramedullary nailing (IMN) has become the preferred treatment method in tibial, femoral shaft, and sub- or intertrochanteric fractures [1-4]. At the time of writing, a PubMed database search using the terms complication AND nail AND fragment AND bone AND joint revealed five cases: three cases of femoral bone fragment penetration to the knee joint, one case of tibial fragment penetration to the ankle joint, and one case of ankle joint perforation by bone fragment [10-12]. Careful examination of postoperative X-rays revealed a 60 x 10 mm bony fragment starting from the distal tip of the nail, going through knee joint space into the medial tibial condyle and perforating its medial cortex (Figures 3-4). A defect of 30 percent of the size of the medial tibial condyle was present in its central part After removal of both cruciate ligaments, a satisfactory ROM of 0/0/80 was reached with NexGen LPS (Zimmer Biomet, Warsaw, Indiana) posterior stabilized total knee prosthesis (Figures 7-8). She is taking care of her livestock and plant farm without any assistance
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