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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

04.11.2020 | Trauma Surgery

Nailing unstable pertrochanteric fractures: does size matters?

verfasst von: Rafael Luque Pérez, Pablo Checa Betegón, María Galán-Olleros, Camila Arvinius, Jose Valle-Cruz, Fernando Marco

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 1/2022

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Abstract

Introduction and objectives

New generation cephalomedullary nails are, currently, widely used for the treatment of trochanteric proximal femoral fractures. This study aims to compare the midterm outcomes and complication rates in patients with unstable 31A2 fractures treated with two different lengths of nails.

Materials and methods

Retrospective study including 123 pertrochanteric proximal femoral fractures 31A2 treated with Gamma3 nail^® between January/2017 and January/2019. 19 patients were excluded, resulting in a total of 104 patients with a minimum follow-up of 1 year. Two groups, Long Dynamic Gamma3 Nail (LGN) and Short Static Gamma3 Nail (SGN), with 52 patients each were compared. Mean age was 81 years (range 50–99), being 78% female. Preoperative variables included: age, medical comorbidities, mobility, anesthetic risk, associated fractures, hemoglobin and hematocrit values. Postoperatively, functional and radiological results, quality of life, hemoglobin and hematocrit concentration, transfusion requirements, mobility, and pain were evaluated. Additionally, perioperative complications were also analyzed, such as malunion, non-union, infection rates, cut-outs, and peri-implant fractures.

Results

A correct radiological fracture reduction was obtained in 73% of the cases (73% SGN/74% LGN). Two patients in LGN group had intraoperative complications (greater trochanter fractures). 38% of the patients with LGN presented nail tip impaction upon the distal anterior femoral cortex, associated with anterior knee pain. Blood loss and operative time was statistically different between groups. Despite the previous, no differences in clinical outcomes and quality of life were found.

Conclusions

The present study comparing two lengths of the Gamma3 Nail in 31A2 fractures showed no overall differences in clinical and radiological outcomes, and complication rates. However, the use of LGN was associated with a statistically significant higher blood loss and operative time, and a tendency for increased need for transfusion, and anterior knee pain and reoperation rate. Therefore, we recommend the use of locked SGN in the treatment of 31A2 fractures.

Guo X, Zhang K, Fu H, Cao W, Dong Q (2015) Original article A comparative study of the therapeutic effect between long and short intramedullary nails in the treatment of intertrochanteric femur fractures in the elderly. Chin J Traumatol 18(6):332–335CrossRef

Boone C, Carlberg KN, Koueiter DM, Baker KC, Sadowski J, Wiater PJ et al (2014) Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31-A1 and A2). J Orthop Trauma 48073:96–100CrossRef

Horner NS, Samuelsson K, Solyom J, Ayeni OR, Ostman B (2017) Implant-related complications and mortality after use of short or long gamma nail for intertrochanteric and subtrochanteric fractures. J Bone Joint Surg 2(3)

Bovbjerg PE, Larsen MS, Madsen CF (2019) Schnnemann failure of short versus long cephalomedullary nail after intertrochanteric fractures. J Fract J Orthop. https://doi.org/10.1016/j.jor.2019.10.018

Kleweno C, Morgan J, Redshaw J et al (2014) Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. J Orthop Trauma 28(7):391–397. https://doi.org/10.1097/BOT.0000000000000036CrossRefPubMed

Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170. https://doi.org/10.1097/BOT.0000000000001063CrossRef

Vicario C, Marco F, Domínguez I, López-Durán L (2000) Tratamiento en el anciano de las fracturas de la región trocantérea femoral con clavo intramedular gamma. Rev Ortop Traumatol 5:434–438

Vicario C, Marco F, Ortega L, Alcobendas M, Dominguez I, López-Durán L (2003) Necrosis of the femoral head after fixation of trochanteric fractures with Gamma Locking Nail. A cause of late mechanical failure. Injury 34(2):129–134. https://doi.org/10.1016/s0020-1383(02)00171-7CrossRefPubMed

Parker MJ (1996) Trochanteric hip fractures. Fixation failure commoner with femoral medialization, a comparison of 101 cases. Acta Orthop Scand 67(4):329–332. https://doi.org/10.3109/17453679609002325CrossRefPubMed

10.

Parker MJ (2000) Handoll HH Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev 2:293–299

11.

Chinzei N, Hiranaka T, Niikura T, Tsuji M, Kuroda R, Doita M, Kurosaka M (2015) Comparison of the sliding and femoral head rotation among three different femoral head fixation devices for trochanteric fractures. Clin Orthop Surg. 7(3):291–297CrossRef

12.

Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ (2010) A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am 92(4):792–798. https://doi.org/10.2106/JBJS.I.00508CrossRefPubMed

13.

Baumgaertner MR, Curtin SL, Lindskog DM (1998) Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res 348:87–94CrossRef

14.

Dunn J, Kusnezov N, Bader J, Waterman BR, Orr J, Belmont PJ (2016) Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review. J Orthop Traumatol. 17(4):361–367. https://doi.org/10.1007/s10195-016-0405-zCrossRefPubMedPubMedCentral

15.

Michael D, Yaniv W, Tal FR et al (2016) Expandable proximal femoral nail versus gamma proximal femoral nail for the treatment of AO/OTA 31A1-3 fractures. Injury 47(2):419–423. https://doi.org/10.1016/j.injury.2015.10.013CrossRefPubMed

16.

Andreani L, Bonicoli E, Piolanti N et al (2015) Prospective randomized controlled trial of two different intramedullary nails for pertrochanteric fractures of the femur. Surg Technol Int. 27:210–214PubMed

17.

Chang SM, Zhang YQ, Ma Z, Li Q, Dargel J, Eysel P (2015) Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg 135(6):811–818. https://doi.org/10.1007/s00402-015-2206-xCrossRefPubMedPubMedCentral

18.

Xu Y, Geng D, Yang H, Wang X, Zhu G (2010) Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3. Orthopedics 33(7):473. https://doi.org/10.3928/01477447-20100526-03CrossRefPubMed

19.

Winnock de Grave P, Tampere T, Byn P, Van Overschelde J, Pattyn C, Verdonk R. Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. A prospective randomised clinical trial. Acta Orthop Belg. 2012;78(2):192‐198

20.

Ceder L (2000) The difficult extracapsular hip fracture (including subtrochanteric). Curr Orthopaedics. 14(2):93–101. https://doi.org/10.1054/cuor.2000.0094CrossRef

21.

Shetty A, Shenoy PM, Swaminathan R (2019) Mismatch of long Gamma intramedullary nail with bow of the femur: does radius of curvature of the nail increase risk of distal femoral complications? J Clin Orthop Trauma. 10(2):302–304. https://doi.org/10.1016/j.jcot.2017.12.006CrossRefPubMed

22.

Zhang Y, Zhang S, Wang S et al (2017) Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review and meta-analysis. Orthop Traumatol Surg Res. 103(5):685–690. https://doi.org/10.1016/j.otsr.2017.04.003CrossRefPubMed

23.

Vaughn J, Cohen E, Vopat BG, Kane P, Abbood E, Born C (2015) Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up. Eur J Orthop Surg Traumatol 25(4):665–670. https://doi.org/10.1007/s00590-014-1557-2CrossRefPubMed

24.

Barquet A, Francescoli L, Rienzi D, López L (2000) Intertrochanteric-subtrochanteric fractures: treatment with the long Gamma nail. J Orthop Trauma 14(5):324–328. https://doi.org/10.1097/00005131-200006000-00003CrossRefPubMed

25.

Pervez H, Parker MJ (2001) Results of the long Gamma nail for complex proximal femoral fractures. Injury 32(9):704–707. https://doi.org/10.1016/s0020-1383(01)00022-5CrossRefPubMed

26.

Anchuela J, Carretero R, San Martín A et al (2002) El clavo Gamma largo en las fracturas extracapsulares del fémur. Rev Ortop y Traumatol. 6:234–238

27.

Li Z, Liang Y, Zhao C, Wu H (2014) Zhonghua Yi Xue Za Zhi. 94(43):3436–3438PubMed

28.

Heiney J, Battula S, Njus G, Ruble C, Vrabec G (2008) Biomechanical comparison of three second-generation reconstruction nails in an unstable subtrochanteric femur fracture model. Proc Inst Mech Eng H. 222(6):959–966. https://doi.org/10.1243/09544119JEIM369CrossRefPubMed

29.

López-Vega M, Gil-Monzó ER, Rodrigo-Pérez JL et al (2015) Estudio prospectivo aleatorizado sobre la influencia del bloqueo distal del clavo Gamma 3 en el tratamiento de las fracturas pertrocantéreas de fémur [Randomized prospective study on the influence distal block and Gamma 3 nail on the treatment of intertrochanteric fractures of femur]. Rev Esp Cir Ortop Traumatol. 59(1):26–35. https://doi.org/10.1016/j.recot.2014.06.004CrossRefPubMed

30.

Mingo-Robinet J, Torres-Torres M, Martínez-Cervell C et al (2015) Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases. J Orthop Trauma 29(3):e85–e90. https://doi.org/10.1097/BOT.0000000000000190CrossRefPubMed

31.

Huang H, Xin J, Ma B. Analysis of complications of intertrochanteric fracture treated with Gamma 3 intramedullary nail. Int J Clin Exp Med. 2014;7(10):3687‐3693. Published 2014 Oct 15

32.

Georgiannos D, Lampridis V, Bisbinas I (2014) Complications following Treatment of Trochanteric Fractures with the Gamma3 Nail: is the Latest Version of Gamma Nail Superior to Its Predecessor? Surg Res Pract. 2014:143598. https://doi.org/10.1155/2014/143598CrossRefPubMedPubMedCentral

33.

Kempf I, Grosse A, Taglang G, Favreul E (2014) Gamma nail in the treatment of closed trochanteric fractures Results and indications of 121 cases. Orthop Traumatol Surg Res. 100(1):75–83. https://doi.org/10.1016/j.otsr.2013.12.013CrossRefPubMed

34.

Westacott D, Bould M (2011) Outcome in 36 elderly patients treated with the Gamma3 Long Nail for unstable proximal femoral fracture. Acta Orthop Belg 77(1):68–72PubMed

Titel: Nailing unstable pertrochanteric fractures: does size matters?
verfasst von: Rafael Luque Pérez
Pablo Checa Betegón
María Galán-Olleros
Camila Arvinius
Jose Valle-Cruz
Fernando Marco
Publikationsdatum: 04.11.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 1/2022
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03668-0

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Nailing unstable pertrochanteric fractures: does size matters?