Failure of a Rotation Control Gamma 3 Lag Screw Used to Treat a Trochanteric Fracture

Choi, Kyungho; Kim, Yongtae; Zhou, Shicheng; Hwang, Jihyo

doi:10.5371/hp.2018.30.2.129

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…This system may be more time consuming due to the management of additional U-blade. The metal failure related to the U-blade was reported as a case report by Choi et al20). In this case, the reduction quality was poor, the TAD was outside of the normal range, and the lag screw was too low in the anteroposterior view of plain radiograph and anterior in the lateral plain radiograph, so these factors may contribute the lag screw failure.…”

Section: Discussionmentioning

confidence: 75%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 75%

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

et al. 2019

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“…After that, the Gamma 3 nail model designed with the use of a U-Blade lag screw was developed to provide improved outcomes when treating patients with unstable proximal femur fractures, and for those at high risk of rotation, this model is the newest model in the Gamma series. So far, there have been limited results for this newest type of Gamma nail [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others?

et al. 2019

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BackgroundIntramedullary hip nails may be classified as blades or screws depending on the type of lag screw used. Recently, a combination of lag screw types with a U-clip insertion has also been used. The purpose of this study was to evaluate the clinical and radiological outcomes of these new screw types.MethodsA total of 185 patients with trochanteric femoral fractures (age ≥ 65 years) who underwent surgery with intramedullary nails were selected. Surgeries with InterTrochanteric/SubTrochanteric (ITST), Proximal Femoral Nail Antirotation (PFNA), and Gamma 3 U-Blade lag screws were performed between January 2011 and June 2016. The AO/OTA classification, presence of a basicervical fracture type on 3D-CT, BMI, BMD, reduction quality, position of the lag screw, TAD (tip apex distance) of the lag screw, sliding distance of the lag screw, varus change (neck shaft angle), radiological union period, fixation failure and functional outcome as determined by walking ability were analyzed.ResultsThere were 3/60 (5.0%) cases of fixation failure in the ITST group, all caused by cut-out; 4/57 (7.0%) in the PFNA II group: 3 caused by cut-through and 1 by metal fracture; 1/68 (1.5%) in the Gamma 3 U-Blade lag screw group (P = 0.301). In each group, the sliding distance of the lag screw showed a significant difference (P = 0.017), whereas significant sliding over 10 mm showed no statistically significant results.ConclusionThere was only one (1.5%) case of fixation failure in the Gamma 3 U-Blade lag screw group. The sliding distance of the U-Blade was found to be in the middle, between the PFNA II (shorter) and ITST (longer) implants. The new rotational control lag screw seems to be comparable to other screw types.

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“…In the literature, a total of 141 events were reported from 3692 cases 20 . However, U-blade hybrid type lag screw failure has rarely been reported 21 . In the literature, the cut-out rates were reported to be about 0–3.3% with the use of an additional U-blade 7 , 9 , 22 – 24 .…”

Section: Discussionmentioning

confidence: 99%

Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures

Kim

Kwon

et al. 2021

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The purpose of this study is to compare the cut-out rate and sliding distance associated with limb length inequality between operations using a standard non-sliding lag screw versus those using a non-sliding lag screw with U-blade (RC) in the Gamma3 nail. This is a retrospective review of two case series involving different lag screws for the Gamma3 nail. Propensity score matching analysis was used to adjust the confounding factors. A comparative analysis of 304 patients who treated with Gamma3 nail with either a standard non-sliding lag screw or a U-Blade (RC) lag screw was performed. Between 2014 and 2018, 152 patients were treated with U-blade (RC) lag screws, and these patients were matched with those treated with standard lag screws. There was no significant difference in cut-out rate between groups. However, additional use of anti-rotation U-blade (RC) could significantly decrease lag screw sliding, with the group treated with U-Blade (RC) lag screws exhibiting shorter sliding, especially in AO/OTA31 A2 and A3 fractures. Also, in A2 and A3 fractures, the mean lag screw sliding distance was greater than that seen in A1 fractures in both groups. These findings can help trauma surgeons choose the proper implant to reduce leg length inequality.

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Failure of a Rotation Control Gamma 3 Lag Screw Used to Treat a Trochanteric Fracture

Cited by 4 publications

References 9 publications

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

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

Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others?

Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures

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