Fracture de la vis cervicale d’une vis-plaque à glissement: À propos d’un cas à 1,5 an de recul

RésuméCette étude rapporte un cas de fracture de vis cervicale survenue sur une vis-plaque à glissement. L’indication de cette vis-plaque à glissement avait été une fracture per-trochantérienne. Compte tenu de la rareté de cet événement (aucun cas à notre connaissance rapporté jusqu’ici dans la littérature), les auteurs discutent le mécanisme de survenue de la fracture de la vis cervicale (insuffisance de la réserve d’impaction et utilisation d’un canon court), ainsi que le traitement de cet événement. La thérapeutique a été l’extraction du fragment de vis distale suivie d’une nouvelle ostéosynthèse armée par du ciment.

Although no cases have been reported to date, fracture of a sliding hip screw on a screw-plate fixation is a real entity since material watch registries have revealed two non-published cases. We report an illustrative case.A 67-year-old man was hospitalized for a right intertrochanteric fracture. The patient was treated with a sliding hip screw plate fixation (short cannon, 105 mm screw). On the eighth postoperative day, fracture impaction was present with complete loss of impaction reserve associated with secondary discrete divergence in the cannon-screw alignment. Weight-bearing was postponed until the 45th postoperative day. At three months, bone healing had not been achieved. A clear image was also visible at the plate end of the cannon. The patient complained of persistent pain but there were no signs of infection. At the fifth month, the patient fell from the standing position and standard x-rays visualized the nonunion of the intertrochanteric fracture plus a infratrochaneric diaphyseal fracture line in addition to a fracture of the sliding hip screw. The plate screws were intact. The patient underwent revision osteosynthesis with a Medoff plate.Fracture of a sliding hip screw is a rare event. In the present case, the mechanism involved an insufficient impaction reserve and use of a short cannon. Treatment requires extraction of the distal fragment of the screw and a new cemented osteosynthesis.