Fractured Gamma nail

Zafiropoulos, George; Pratt, D.J.

doi:10.1016/0020-1383(94)90248-8

Cited by 53 publications

(21 citation statements)

References 16 publications

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“…The proximal nail is narrowest in cross-section at the site of the cephalic lag screw. 15 In addition, it is subjected to the torque of the patient load against the cephalic lag screw, in the absence of the calcar. The stresses in the subtrochanteric region are the highest in the human body at 1200 lb/square inch.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

Johnson

Uzoigwe

Venkatesan

et al. 2017

annals

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INTRODUCTION Intramedullary nailing is a common treatment for proximal femoral fractures. Fracture of the nail is a rare but devastating complication that exposes often frail patients to complex revision surgery. We investigated which risk factors predict nail failure. METHODS We reviewed all cases of nail breakage seen over a 10-year period in a single busy trauma unit; 22 nail fractures were seen in 19 patients. Comparison was made with a group of 209 consecutive patients who underwent intramedullary fixation of a proximal femur fracture with no nail breakage over a 2-year period. RESULTS In the fractured nail group, mean age was 70.4 years (range 55-88 years).The mean time to fracture was 10 months (range 2.5-23 months). Logistical regression was used to show that low American Society of Anesthesiologists (ASA) score, subtrochanteric fracture and pathological fracture were independent risk factors for nail fracture. CONCLUSIONS Young patients with a low ASA score are at highest risk of nail breakage. We advise close follow-up of patients with these risk factors until bony union has been achieved. In addition, there may be merit in considering other treatment options, such as proximal femoral replacement, especially for those with pathological fracture with a good prognosis.

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Section: Discussionmentioning

confidence: 99%

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

Johnson

Uzoigwe

Venkatesan

et al. 2017

annals

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“…3 The gamma nail fixation is recommended for pertrochanteric fractures, but serious complications such as cut-out of lag screws have been reported in 8 to 15% of cases. [4][5][6] The proximal femoral nail (PFN) has an additional anti-rotational screw (hip pin) placed in the femoral neck to avoid rotation of the cervicocephalic fragments during weight bearing. 7,8 We report outcomes of 87 consecutive patients treated with a PFN for trochanteric femoral fractures.…”

Section: Introductionmentioning

confidence: 99%

Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures

Morihara

Arai

Tokugawa

et al. 2007

J Orthop Surg (Hong Kong)

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Purpose. To report outcomes of 87 consecutive patients treated with a proximal femoral nail (PFN) for trochanteric femoral fractures. Methods. 17 men and 70 women aged 58 to 95 (mean, 85) years with trochanteric femoral fractures underwent PFN fixation using an intramedullary nail, a lag screw, and a hip pin. Fractures were classified according to the AO system; the most common fracture type was A2 (n=45), followed by A1 (n=36) and A3 (n=6). The position of the lag screw within the femoral head was measured. The lateral slide of the lag screw after fracture consolidation was measured by comparing the immediate postoperative and final anteroposterior radiographs. Results. 90% of lag screws were placed in an optimal position. The length of lateral slide of the lag screw in stable A1 fractures was significantly less than that in unstable A2 fractures; it was over 10 mm in 7 of 45 patients with A2 fractures. Cut-out of lag screw did not occur, suggesting that free sliding of the lag screw facilitates direct impaction between fragments. Conclusion. A PFN is useful for the treatment of trochanteric femoral fractures.

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“…In unstable fractures, the lesser trochanter and part of calcar femorale are missing from the mechanical load transmission system and because of the lack of bony support over the medial aspect of femur, the proximal fragment easily collapses (varus) and internally rotates under the physiologic loads 30. The inferior placements of helical blades in the frontal plane and centrally in the sagittal plane inherently support the comminuted posteromedial cortex and allow compaction of fracture suface, shortening the lever arm, decreasing the bending moment, thus avoiding cutout of screw from the femoral head.…”

Section: Discussionmentioning

confidence: 99%

A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

Hwang

Garg²,

et al. 2012

IJOO

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Objective:Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA). The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center) of the helical blade in the femoral head in unstable trochanteric fractures.Materials and Methods:Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C) group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C) group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failureResults:Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship.Conclusion:The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres.

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Fractured Gamma nail

Cited by 53 publications

References 16 publications

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

Proximal Femoral Nail for Treatment of Trochanteric Femoral Fractures

A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

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