Comparison of third generation long Gamma nail and femur intramedullary nail for the treatment of femoral subtrochanteric fractures

Yıl 2021, Cilt: 5 Sayı: 3, 249 - 254, 01.03.2021

Şahin Çepni , Enejd Veizi , Ali Şahin , Ahmet Fırat , Özay Subaşı , Yağmur Polat

https://doi.org/10.28982/josam.869618

Öz

Background/Aim: Internal fixation is the current gold standard procedure in treatment of subtrochanteric femur fractures. One of the most common causes of morbidity after subtrochanteric femoral fracture treatment is mechanical complications, such as implant failure. The aim of this study is to share our experience and compare the radiological and functional results of two different fixation implants in patients with subtrochanteric fractures.
Methods: A cohort of 57 patients with a subtrochanteric fracture operated using a third generation Gamma nail (G3LN) or an anterograde intramedullary nail (AIMN) were prospectively followed up. Twenty-eight underwent fracture fixation with the Gamma nail while the other twenty-nine were operated using a conventional AIMN. All patients were followed up until union or, in case of a revision, healing and recovery. Their radiological findings were retrospectively analyzed, and the functional results were assessed using a Harris Hip Score.
Results: Data regarding demographic properties such as sex, trauma mechanism and smoking were similar for the subgroups (P<0.05 for each). Blood loss amount, surgery time, hospital stay and follow up time were also similar between the two groups (P>0.05 for each). Compared to the AIMN group, whose reduction was mostly acceptable (48.28%), the majority of G3LN patients (57.14%) had an anatomical reduction on early follow up. Most fractures, regardless of the implant used, needed an open reduction. Both implants showed similar union time and had similar final HHS scores. None of the complication rates reached statistical significance between the two groups (P>0.05 for each).
Conclusion: Both third-generation Gamma Nail implant and anterograde intramedullary nailing are viable means of fixation for subtrochanteric hip fractures. They lead to similar and few complications while providing a rigid and secure fixation. These findings lead us to believe that good reduction and adherence to the principles of internal fixation rather than implants used are the key to success in the treatment of subtrochanteric fractures.

Anahtar Kelimeler

subtrochanteric femur fracture, gamma nail, antegrade intramedullary nail

Kaynakça

• 1. Joglekar SB, Lindvall EM, Martirosian A. Contemporary management of subtrochanteric fractures. Orthop Clin North Am. 2015;46:21-35.
• 2. Codesido P, Mejía A, Riego J, Ojeda-Thies C. Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction. Arch Orthop Trauma Surg. 2017;137:1077-85.
• 3. Matre K, Havelin LI, Gjertsen J-E, Vinje T, Espehaug B, Fevang JM. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register. Injury. 2013;44:735-42.
• 4. Celebi L, Can M, Muratli H, Yagmurlu M, Yuksel H, Bicimoğlu A. Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur. Injury. 2006;37:740-50.
• 5. Saini P, Kumar R, Shekhawat V, Joshi N, Bansal M. Biological fixation of comminuted subtrochanteric fractures with proximal femur locking compression plate. Injury. 2013;44:226-31.
• 6. Panteli M, Mauffrey C, Giannoudis PV. Subtrochanteric fractures: Issues and challenges. Injury. 2017;48:2023-6.
• 7. Hesse B, Gächter A. Complications following the treatment of trochanteric fractures with the gamma nail. Arch Orthop Trauma Surg. 2004;124:692-8.
• 8. Henschel J, Eberle S, Augat P. Load distribution between cephalic screws in a dual lag screw trochanteric nail. J Orthop Surg Res. 2016;11:41.
• 9. Jiang L-S, Shen L, Dai L-Y. Intramedullary fixation of subtrochanteric fractures with long proximal femoral nail or long gamma nail: technical notes and preliminary results. Ann Acad Med Singap. 2007;36:821.
• 10. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am. 1978;60:300-6.
• 11. Corrales LA, Morshed S, Bhandari M, Miclau III T. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am. 2008;90:1862.
• 12. Yang JS, Otero J, McAndrew CM, Ricci WM, Gardner MJ. Can tibial nonunion be predicted at 3 months after intramedullary nailing? J Orthop Trauma. 2013;27:599.
• 13. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77:1058-64. Epub 1995/07/01. doi: 10.2106/00004623-199507000-00012. PubMed PMID: 7608228.
• 14. Li S, Chang S-M, Jin Y-M, Zhang Y-Q, Niu W-X, Du S-C, et al. A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury. 2016;47:1302-8.
• 15. Velasco RU, Comfort TH. Analysis of treatment problems in subtraochanteric fractures of the femur. J Trauma. 1978;18:513-23.
• 16. Kilinc BE, Oc Y, Kara A, Erturer RE. The effect of the cerclage wire in the treatment of subtrochanteric femur fracture with the long proximal femoral nail: A review of 52 cases. Int J Surg. 2018;56:250-5.
• 17. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2010.
• 18. Lotzien S, Rausch V, Schildhauer TA, Gessmann J. Revision of subtrochanteric femoral nonunions after intramedullary nailing with dynamic condylar screw. BMC Musculoskelet Disord. 2018;19:448.
• 19. Kuzyk PR, Bhandari M, McKee MD, Russell TA, Schemitsch EH. Intramedullary versus extramedullary fixation for subtrochanteric femur fractures. J Orthop Trauma. 2009;23:465-70.
• 20. Perren S, Fernandez Dell'oca A, Regazzoni P. Fracture fixation using cerclage: research applied to surgery. Acta Chir Orthop Traumatol Cech. 2015;82:389-97.
• 21. Gadegone WM, Shivashankar B, Lokhande V, Salphale Y. Augmentation of proximal femoral nail in unstable trochanteric fractures. Sicot-j. 2017;3.
• 22. Utrilla AL, Reig JS, Muñoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma. 2005;19:229-33.
• 23. Massoud EIE. Fixation of intracapsular femoral neck fractures: Effect of trans-osseous capsular decompression. Dicle Medical Journal/Dicle Tip Dergisi. 2010;37.
• 24. Frihagen F, Grotle M, Madsen JE, Wyller TB, Mowinckel P, Nordsletten L. Outcome after femoral neck fractures: a comparison of Harris Hip Score, Eq-5d and Barthel Index. Injury. 2008;39:1147-56.
• 25. Hayashi D, Gould ES, Ho C, Caruana DL, Komatsu DE, Yang J, et al. Severity of heterotopic ossification in patients following surgery for hip fracture: a retrospective observational study. BMC Musculoskelet Disord. 2019;20:348.