Clinical Outcomes of U-blade Gamma3 Nails Used to Treat Patients with Trochanteric Fractures: Retrospective Multicenter Study

Abstract

Purpose This study was performed to assess the radiologic and clinical results of U-blade Gamma3 nail use for the treatment of trochanteric fractures. Materials and Methods Between September 2015 and May 2018, all patients aged 65 years and older who underwent surgery with U-blade Gamma3 nails were analyzed. A total of 129 patients were selected based on having at least six months of follow-up. Image evaluations included bone quality (T-score), fracture classification on plain radiograph (AO/OTA), computed tomography configuration, union period, position of lag screw, anatomical reduction, tip apex distance (TAD), sliding extent of lag screw, change of neck shaft angle, and complications leading to reoperations were analyzed. Functional outcome were assessed using the Koval grade (ambulatory ability) at the final follow-up. Results The mean time to union was 19.7 (range, 6–36) weeks. The screw position was centric (93 cases; 72.1%) and anatomical reduction was achieved in 74 cases (57.4%). The mean TAD was 20.3 (range, 12.3–38.1) mm. The mean sliding length of the lag screws was 3.8 (range, 0.1–12.6) mm. The mean change of neck shaft angle was 3.4° (range, 0–12.8°). Reoperations were required in two cases (1.6%) due to the cutting out of the lag screw (n=1) and metal failure with U-blade bending (n=1). Finally, Koval grades for 49.8% of patients reached preoperative status. Conclusion Overall, use of the U-blade Gamma3 nail led to favorable clinical results, suggesting that this system may be a good option for the treatment of trochanteric fractures.

U-blade gamma 3 vs. gamma 3 nails for intertrochanteric hip fracture: Meta-analysis

“…Regarding the cut-out and lateralization rate, it seems expected to be lower with the U-Blade nail, but there were no significant differences in the lateralization and cut-out rate. The cut-out rate with the conventional Gamma 3 nail and the U-Blade Gamma 3 was 3.6% and 1.8% respectively, which is in accordance with the literature ( 8 , 21 ). Lang et al showed a lower rate of cut-out with U-Blade Gamma 3 nails ( 18 ).…”

“…Thus, different types of implants have been developed according to the features of each patient. U-Blade devices appeared to avoid rotation of the femoral head over the femoral neck or migration of the cephalic screw, among other complications in unstable fractures ( 8 ). U-Blade nails represent the third and most current generation of gamma nails ( 9 ).…”

Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases

“…Blood loss was reduced significantly from approximately 700 mL in the previous study reported by Park et al 20) in which the conventional PL approach was used for treatment of unstable intertrochanteric fractures in elderly patients. The mean visible blood loss in unstable intertrochanteric fractures treated using intramedullary nails was a 200 mL 21) . In our study the amount of blood loss was close to that of intramedullary nailing.…”

Conventional versus helical blade screw insertion following the removal of the femoral head screw: a biomechanical evaluation using trochanteric gamma 3 locking nail versus PFN antirotation

“…Despite successful outcomes of treating IT Fx using the NSH [4,5], revision is often required due to treatment failure, such as femoral head perforation, nonunion, loss of reduction, and periprosthetic fracture [12,13]. Options for the revisional surgery include changing the hip screw and intramedullary nail [14], salvage procedures that augment the bone cement on the cancellous bone in the femoral head before changing the hip screw [15], and hip arthroplasty.…”

“…The representative types of hip screws inserted into the femoral head in the NSH system are the conventional-type (C-type) and helical blade-type (H-type) screw; the most stable insertion site is the center-center of the femoral head [3]. Although the NSH system has been successfully used for treating IT Fx [4,5], the overall rate of mechanical complications was reportedly 8% [6] in Gamma nail and 10.8% [7] in PFNA; thus, revisions may be required for to prevent fixation failure or trauma. Bojan et al [8] reported that fixation failure following intramedullary fixation occurred in patients with at least one of the major factors: fracture classification, inadequate reduction, and improper positioning of the delay screw.…”