Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures

Quality of life after pertrochanteric femoral fractures treated with a gamma nail: a single center study of 62 patients

“…Consistent with previous authors, [10,11,17] we had a technical failure rate of 3%. Earlier studies have reported higher complication rates associated with the use of previous versions of GN [2,27] Secondary femoral fractures did not occur in our study but have been reported in other studies with an incidence up to 17% [9]. Cut-out of the lag screw, which we observed in one patient, might have been avoided by positioning the tip of the lag screw in the subchondral bone of the femoral head [18].…”

Quality of life after pertrochanteric femoral fractures treated with a gamma nail: a single center study of 62 patients

“…Consistent with previous authors, [10,11,17] we had a technical failure rate of 3%. Earlier studies have reported higher complication rates associated with the use of previous versions of GN [2,27] Secondary femoral fractures did not occur in our study but have been reported in other studies with an incidence up to 17% [9]. Cut-out of the lag screw, which we observed in one patient, might have been avoided by positioning the tip of the lag screw in the subchondral bone of the femoral head [18].…”

Answer to Handoll and Parker

“…DSIN devices tended to cause a lower proportion of cut out than DSP devices when considering data for unstable fractures only (overall relative risk =0.51; 95% CI=0.15-1.7) and the reverse results from mixed data (overall relative risk =1.8; 95% CI=1.0-3.2). Our conclusions were targeted at unstable fractures, and thus we do not feel contradicted findings from Parker and Handoll [5].…”

“…As mentioned in our introduction, the objective of the review was focused on unstable fractures, without duplicating the review of Parker and Handoll [5]. We fully agree that results from sub-group analyses may be misleading and should be interpreted with caution.…”

Proximal Femoral Fractures

“…One of the key findings of the Cochrane-database research [32] was that using nails increases the risk of later femur fractures and the rate of re-operations which seemed to be the main difference between the intra-and extramedullary implants. More distal and uncommon trochanteric fractures such as subtrochanteric and reversed oblique ones should be better fixed with intramedullary devices in regard to fracture fixation failure.…”

“…Unfortunately, the Cochrane search did not differentiate parameters of outcome and complications in relation to fracture classification. With respect to this shortcoming, the comparison of short femoral nails versus DHS has to be considered with an incidence of non-union with 0.7 % to 0.7 %, the technical complications of fixation for all fracture types encountered in 7.5 % to 3.6 % and a reoperation rate that was quite similar with 5.8 % to 3.5 % [32]. Nevertheless the review showed that intramedullary stabilization for pertrochanteric fractures can be a demanding procedure, where there is no significant difference in complications referring to the experience of the surgeon [32,39].…”

Quality of life after pertrochanteric femoral fractures treated with a gamma nail: a single center study of 62 patients

“…Consistent with previous authors, [10,11,17] we had a technical failure rate of 3%. Earlier studies have reported higher complication rates associated with the use of previous versions of GN [2,27] Secondary femoral fractures did not occur in our study but have been reported in other studies with an incidence up to 17% [9]. Cut-out of the lag screw, which we observed in one patient, might have been avoided by positioning the tip of the lag screw in the subchondral bone of the femoral head [18].…”

Answer to Handoll and Parker

“…DSIN devices tended to cause a lower proportion of cut out than DSP devices when considering data for unstable fractures only (overall relative risk =0.51; 95% CI=0.15-1.7) and the reverse results from mixed data (overall relative risk =1.8; 95% CI=1.0-3.2). Our conclusions were targeted at unstable fractures, and thus we do not feel contradicted findings from Parker and Handoll [5].…”

“…As mentioned in our introduction, the objective of the review was focused on unstable fractures, without duplicating the review of Parker and Handoll [5]. We fully agree that results from sub-group analyses may be misleading and should be interpreted with caution.…”

Proximal Femoral Fractures

“…One of the key findings of the Cochrane-database research [32] was that using nails increases the risk of later femur fractures and the rate of re-operations which seemed to be the main difference between the intra-and extramedullary implants. More distal and uncommon trochanteric fractures such as subtrochanteric and reversed oblique ones should be better fixed with intramedullary devices in regard to fracture fixation failure.…”

“…Unfortunately, the Cochrane search did not differentiate parameters of outcome and complications in relation to fracture classification. With respect to this shortcoming, the comparison of short femoral nails versus DHS has to be considered with an incidence of non-union with 0.7 % to 0.7 %, the technical complications of fixation for all fracture types encountered in 7.5 % to 3.6 % and a reoperation rate that was quite similar with 5.8 % to 3.5 % [32]. Nevertheless the review showed that intramedullary stabilization for pertrochanteric fractures can be a demanding procedure, where there is no significant difference in complications referring to the experience of the surgeon [32,39].…”

Quality of life after pertrochanteric femoral fractures treated with a gamma nail: a single center study of 62 patients

“…Consistent with previous authors, [10,11,17] we had a technical failure rate of 3%. Earlier studies have reported higher complication rates associated with the use of previous versions of GN [2,27] Secondary femoral fractures did not occur in our study but have been reported in other studies with an incidence up to 17% [9]. Cut-out of the lag screw, which we observed in one patient, might have been avoided by positioning the tip of the lag screw in the subchondral bone of the femoral head [18].…”

Answer to Handoll and Parker

“…DSIN devices tended to cause a lower proportion of cut out than DSP devices when considering data for unstable fractures only (overall relative risk =0.51; 95% CI=0.15-1.7) and the reverse results from mixed data (overall relative risk =1.8; 95% CI=1.0-3.2). Our conclusions were targeted at unstable fractures, and thus we do not feel contradicted findings from Parker and Handoll [5].…”

“…As mentioned in our introduction, the objective of the review was focused on unstable fractures, without duplicating the review of Parker and Handoll [5]. We fully agree that results from sub-group analyses may be misleading and should be interpreted with caution.…”

Proximal Femoral Fractures

“…One of the key findings of the Cochrane-database research [32] was that using nails increases the risk of later femur fractures and the rate of re-operations which seemed to be the main difference between the intra-and extramedullary implants. More distal and uncommon trochanteric fractures such as subtrochanteric and reversed oblique ones should be better fixed with intramedullary devices in regard to fracture fixation failure.…”

“…Unfortunately, the Cochrane search did not differentiate parameters of outcome and complications in relation to fracture classification. With respect to this shortcoming, the comparison of short femoral nails versus DHS has to be considered with an incidence of non-union with 0.7 % to 0.7 %, the technical complications of fixation for all fracture types encountered in 7.5 % to 3.6 % and a reoperation rate that was quite similar with 5.8 % to 3.5 % [32]. Nevertheless the review showed that intramedullary stabilization for pertrochanteric fractures can be a demanding procedure, where there is no significant difference in complications referring to the experience of the surgeon [32,39].…”