Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures

Han, Seung-Beom; Jung, Jin Yong; Jang, Chul-Young; Kwak, Dae-Kyung; Kim, Jeong-Woo; Yoo, Je-Hyun

doi:10.1038/s41598-020-62980-2

Cited by 8 publications

(4 citation statements)

References 32 publications

(45 reference statements)

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“…The presence of a BCF was the most significant risk factor for postoperative screw cut-out, regardless of the fixation device used. Several studies have recently reported favorable clinical results using improved nail designs, such as a rotationcontrolled lag screw with a U-clip, a helical blade, and twin interlocking derotation and compression screws [15,[25][26][27]. Large-scale randomized prospective studies are…”

Section: Discussionmentioning

confidence: 99%

Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: a retrospective study

Yoon

Park

Kim

et al. 2022

BMC Musculoskelet Disord

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Backgrounds The basic method of surgical treatment for extracapsular hip fractures (ECFs), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for these fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out. Methods We retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group. Results We used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients’ high body mass index (BMI) (p = 0.019), BCFs (p = 0.007), non-extramedullary reduction in the anteroposterior and lateral planes (p = 0.032 and p = 0.043, respectively), and anti-rotation screw pull-outs (p = 0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated (p = 0.020). In the multivariate analysis of group 1, the patients’ BMIs (p = 0.024) and BCFs (p = 0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out. Conclusions The cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: a retrospective study

Yoon

Park

Kim

et al. 2022

BMC Musculoskelet Disord

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“…3 In addition to the continuous improvements in implant design to enhance fixation stability, short CMNs have showed favourable outcomes for the aforementioned fractures. 4…”

Section: Introductionmentioning

confidence: 99%

“…3 In addition to the continuous improvements in implant design to enhance fixation stability, short CMNs have showed favourable outcomes for the aforementioned fractures. 4 As the ageing population increases, the number of elderly patients who suffer unstable pertrochanteric fractures with marked osteoporosis and the corresponding risk of fixation failure in this population increases. 5 In osteoporotic elderly patients, the medullary canal diameter widens, whereas the cortex becomes thinner, 6 and the variety of usable short CMN diameters is limited in practical terms due to stock issues (although this may be slightly different for each manufacturer).…”

Section: Introductionmentioning

confidence: 99%

Effect of the additional anteroposterior blocking screw on nail/medullary canal mismatch after cephalomedullary nailing in unstable pertrochanteric fracture

Kwak

Lee

et al. 2022

Bone & Joint Research

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Aims There are concerns regarding nail/medullary canal mismatch and initial stability after cephalomedullary nailing in unstable pertrochanteric fractures. This study aimed to investigate the effect of an additional anteroposterior blocking screw on fixation stability in unstable pertrochanteric fracture models with a nail/medullary canal mismatch after short cephalomedullary nail (CMN) fixation. Methods Eight finite element models (FEMs), comprising four different femoral diameters, with and without blocking screws, were constructed, and unstable intertrochanteric fractures fixed with short CMNs were reproduced in all FEMs. Micromotions of distal shaft fragment related to proximal fragment, and stress concentrations at the nail construct were measured. Results Micromotions in FEMs without a blocking screw significantly increased as nail/medullary canal mismatch increased, but were similar between FEMs with a blocking screw regardless of mismatch. Stress concentration at the nail construct was observed at the junction of the nail body and lag screw in all FEMs, and increased as nail/medullary canal mismatch increased, regardless of blocking screws. Mean stresses over regions of interest in FEMs with a blocking screw were much lower than regions of interest in those without. Mean stresses in FEMs with a blocking screw were lower than the yield strength, yet mean stresses in FEMs without blocking screws having 8 mm and 10 mm mismatch exceeded the yield strength. All mean stresses at distal locking screws were less than the yield strength. Conclusion Using an additional anteroposterior blocking screw may be a simple and effective method to enhance fixation stability in unstable pertrochanteric fractures with a large nail/medullary canal mismatch due to osteoporosis. Cite this article: Bone Joint Res 2022;11(3):152–161.

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“…Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) associated with comminution of the posterior cortex, are known to be at high risk of fixation failure, including implant cut-out [3] . Therapy failure is mainly caused by varus collapse of the femoral head fragment and/or implant cut-out [4] .…”

Section: Introductionmentioning

confidence: 99%

Screw-blade fixation systems for implant anchorage in the femoral head: Horizontal blade orientation provides superior stability

Schopper

Keck

Migliorini

et al. 2021

Injury

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Objectives: Despite continual improvement in the methods and devices used for treatment of proximal femoral fractures, unacceptably high failure rates remain. Novel screw-blade implant systems, combining a lag screw with a blade -the latter adding rotational stability to the femoral head -offer improvement of osseous purchase, especially in osteoporotic bone. The aim of this study was to compare biomechanically the head element (HE) anchorage of two screw-blade implant systems differing in blade orientation in the femoral head -vertical versus horizontal.Methods: Twenty paired human cadaveric femoral heads were assigned to four groups ( n = 10), implanted with either Rotationally Stable Screw-Anchor HE (RoSA-HE, vertical blade orientation) or Gamma3 Rotation Control Lag Screw (Gamma-RC, horizontal blade orientation) in center or off-center position, and biomechanically tested until failure under progressively increasing cyclic loading at 2 Hz.Results: Cycles to failure and failure load were significantly higher for Gamma-RC versus RoSA-HE in center position and not significantly different between them in off-center position, p = 0.03 and p = 0.22, respectively. In center position, the progression of both rotation around implant axis and varus deformation over time demonstrated superiority of the implant with horizontal versus vertical blade orientation. Compared with center positioning, off-center implant placement led to a significant decrease in stiffness, cycles to failure and failure load for Gamma-RC, but not for RoSA-HE, p < 0.01 and p = 0.99, respectively. Conclusion:Horizontal blade orientation of screw-blade implant systems demonstrates better anchorage in the femoral head versus vertical blade orientation in center position. As the stability of the implant system with horizontal blade orientation drops sharply in off-center position, central insertion is its placement of choice.

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Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures

Cited by 8 publications

References 32 publications

Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: a retrospective study

Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: a retrospective study

Effect of the additional anteroposterior blocking screw on nail/medullary canal mismatch after cephalomedullary nailing in unstable pertrochanteric fracture

Screw-blade fixation systems for implant anchorage in the femoral head: Horizontal blade orientation provides superior stability

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