Objective To investigate the clinical feasibility and efficacy of using a humeral intramedullary nail for the treatment of subtrochanteric fracture in a patient with ipsilateral poliomyelitis sequelae. Methods A case of a 54-year-old female patient with a left subtrochanteric fracture caused by a traffic accident was reported. The patient had a 50-year history of ipsilateral poliomyelitis, leading to developmental deformity and severe stenosis of the femoral medullary canal in the affected limb, which could not accommodate a conventional femoral intramedullary nail. Therefore, we innovatively used a 7 mm diameter humeral interlocking intramedullary nail for internal fixation. Limited open reduction was performed during surgery, supplemented with cerclage wiring to enhance fracture stability. The medullary canal was reamed to 8 mm, after which the nail was successfully inserted. Results The surgical procedure was smooth. Intraoperative fluoroscopy and postoperative x-rays showed satisfactory fracture reduction and good positioning of the internal fixation. The patient was followed up for 30 months. Imaging examinations confirmed bony union of the fracture without complications such as failure of internal fixation. Ultimately, the walking and flexion functions of the left lower limb recovered to the pre-injury level. Conclusion For special types of subtrochanteric fractures with severe femoral medullary canal stenosis due to conditions like poliomyelitis sequelae, the application of a humeral intramedullary nail is a safe and effective innovative treatment strategy. This approach provides reliable intramedullary fixation. This experience offers a valuable reference for managing similar complex orthopedic problems.
Yu et al. (Thu,) studied this question.