Analysis of 2 cases of steel needle fracture in dynamic hip screw (DHS) internal fixation

In the process of strengthening the ankle joint flexion and extension activities, the activity is from small to large. 35 days can go to the ground to carry the weight-bearing walking, when carrying the weight, try to use the heel to land 45 days to help the body to practice the lower jaw movement, exercise as far as possible to lean forward, promote the contraction of the ankle joint capsule and the triceps rehabilitation of the calf Achilles tendon rupture is a more serious injury, such as improper treatment can cause serious obstacles to lower limb function, causing great pain to patients. In the course of treatment, surgical repair and postoperative local care are important links. Avascular necrosis at the edge of the skin incision is a serious complication after Achilles tendon surgery, and it is also a key part of nursing. It is related to the success and failure of the operation to guide effective functional exercise. It is an important measure for the recovery of ankle function. Systematic and holistic care after repair and reconstruction is of great significance.

Analysis of mistakes in diagnosis and treatment of dynamic hip screw (DHS) internal fixation operation of 2 cases of steel needle fracture analysis Dongsheng Hospital, Zhongshan City, Guangdong Province (528414) Huang Yibin Wu Jinchang Wu Jing 1 Case introduction case 3 female, 37 years old. The patient suffered from a severe pain in the right hip due to a car accident and was dysfunctional for 2 hours. He was diagnosed as a comminuted fracture of the right femur by X-ray examination. It belongs to the 31-A2.1 type in the AO classification. Under the epidural anesthesia, the right femoral trochanteric DHS was fixed. After the DHS screw was screwed in, the needle was taken out and the patient was removed after the violent pullout. The hip joint was examined without abnormality. The X-ray film was reviewed on the 2nd day after surgery. A steel needle enters the pelvic cavity 2.5cm, and the needle tail is connected with the DHS screw in the femoral head. The operation is performed again. The right iliac groin incision enters the pelvic cavity and the broken guide needle of 6 cm is taken out. No intraoperative pelvic organ injury is found during the operation.

Example 3 male, 19 years old. The patient suffered from severe pain in the left hip due to falling on a motorcycle and was admitted to the hospital with dysfunction for 10 days. X-ray examination confirmed the intertrochanteric fracture of the left femur. It belongs to the 31-A1.1 type in the AO classification. After DHS screw fixation in the left femoral trochanter DHS under epidural anesthesia, the position of the screw was examined with a C-arm X-ray machine. It was found that there was a steel needle of about 8 cm in length in the femoral head and neck, and the tip penetrated into the acetabulum. The three steel needles that were pulled out were examined, and it was found that the Kirschner wire with one temporarily fixed fracture was shortened. Remove the DHS screw and drill the hole into the hole to probe the tail of the jacket, but fail to remove it. Extend the incision to expose the front of the femoral neck, open 1cm < 2cm bone groove exploration, and finally take out the broken Kirschner wire.

2 Discussion For the femoral trochanteric fracture, the mechanical stability of the internal fixation is high. DHS has dynamic and static compression effect, the structure is firm, the fixation is firm, and the patient can move down early. It is currently treating the intertrochanteric fracture of the femur. The ideal internal fixation material. Due to the convenience of operation, DHS is becoming more and more popular in primary hospitals. However, DHS internal fixation may cause serious consequences. The two cases in this group are caused by improper operation. The analysis is as follows.

2.1 Analysis of the cause of the error 1 After the fracture reduction, the temporarily fixed Kirschner wire or the guide needle penetrated the deep surgeon. After the fracture reduction, the depth of the above-mentioned steel needle drilling was not well mastered, so that the fracture was firmly fixed to facilitate the next DHS internal fixation. The operation of the needle is drilled out of the femoral head and into the hip bone. In the absence of C-arm X-ray machine monitoring, the steel needle is easily mistaken into the pelvic cavity. 2 When reaming with an electric drill, the direction of the reamer and the guide pin are not completely identical, so that the guide pin is slightly bent, so that the leading edge of the reamer will cut the bent portion of the guide pin, and at the same time push the guide pin forward, even through the hip joint into the pelvis . When the intersection of the 32 needles in the direction is too close, when the hole is reamed with the electric drill, the coarse reamer encounters the blocked K-wire, and there is no room for adjustment, and the K-wire is cut off. The reamer can also push the broken Kirschner wire inward or even into the pelvic cavity. When the K-wire or the guide needle is cut by the cutter, it is not completely broken. When the DHS screw is pressed, the steel needle is pressed, and the steel needle will have resistance. When the surgeon pulls out the steel needle with violence, it is easy to cause the steel needle to break. After the needle is broken, if a single Kirschner wire is worn on the femoral head and the acetabulum, the needle becomes the axis of rotation of the hip joint, and the abnormality can be detected during the flexion and extension hip joint examination. 2.2 Precautionary measures 1 The thickness is appropriate, the steel is excellent, Straight and crack-free Kirschner wire and guide pin. 2 When the fracture is reset, the direction of the Kirschner wire that is temporarily fixed is as close as possible to the direction of the DHS screw, and a certain distance is maintained from the guide needle to prevent the Kirschner wire from being damaged when the reamer is reamed. 3 The length of the femoral head neck is measured on the X-ray film, and the depth at which the steel needle is driven is expected. In the case of effectively fixing the fracture, the steel needle should not be inserted into the hip bone to prevent the Kirschner wire from penetrating into the pelvic cavity. 4 After drilling the cortical bone with a thick reamer, it is not advisable to use the electric drill when continuing to ream the hole. The “f-type wrench” should be used to sense the resistance of the drilling. Even if it hits the blocked steel needle, it will not break. When the reamer passes through the cortical bone and does not reach the femoral head, there is resistance. When the Kirschner wire has a plucking sensation, it proves that the Kirschner wire meets the reamer. At this time, the affected K-wire should be pulled out and changed. After the direction is fixed, continue to ream the hole. When the reamer drills into the hole and the guide pin rotates into the bone following the reamer, it is proved that the guide pin is cut by the reamer. At this time, the extra-bone length of the guide pin should be maintained. When the direction of the reamer is drilled and the 5DHS screw is removed, the steel needle should be used on the bone drill, and the steel needle tail should be slowly rotated in the opposite direction. If the steel needle is out of resistance, the blocking of the DHS screw should be considered. First, unscrew the screw and then pull out the steel needle instead of using violence to prevent the steel needle from breaking. 6 The exiting steel needle must be checked for completeness so that the broken needle can be found early. 2.3 Treatment method 1 Steel needle breaks through In the pelvic cavity, it is necessary to probe the pelvic cavity to take out the broken needle. And check whether there is damage in the surrounding organs and deal with it accordingly. 2 The steel needle is broken and left in the femoral head and neck. The DHS screw is drilled into the hole for exploration and the broken needle is compared. If the steel needle is not into the hip joint, the fracture will be cured and DHS. ―And take it out.

If the steel needle has entered the hip joint, it should be taken out early. The incision can be extended to expose the front of the femoral neck, and the grooving can be used to detect the broken needle.

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