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

Abstract

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.

Review on Basicervical Femoral Neck Fracture: Definition, Treatments, and Failures

“…However, Massoud 3) have suggested that an anti-rotational screw should be added to control rotational instability after surgery because the lag screw has potential to rotate the rotationally unstable femoral head during its insertion. Authors of recent reports included in this study argue that the antirotational effect of implant should be taken into account when selecting an implant for the fixation of these rotationally unstable fractures [14][15][16][17][18][19] .…”

“…Proximal fragment included part of the lesser trochanter (black arrow). (B B) Schematic figure depicting the radiograph in the study of Yoo et al 19) . The lesser trochanter fragment is displaced (black arrow).…”

“…16.5 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) 80 (68-88) From the first postoperative day, all patients started weight-bearing walking as tolerable with a walker.…”

“…19.6 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) 84.9 (65-99) Not mentioned.…”

“…Yoo et al 19) the patients were allowed to walk using the parallel bar or rolling walker. Various weight-bearing training exercises were performed not based on the reduction or bone quality but only based on the subject' s pain level and medical condition.…”