Intertrochanteric-Subtrochanteric Fractures: Treatment With the Long Gamma Nail

Barquet, Antonio; Francescoli, Luis; Rienzi, Daniel; López, Luis López

doi:10.1097/00005131-200006000-00003

Cited by 113 publications

(58 citation statements)

References 14 publications

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“…The advantages of the endomedullary nail are lesser blood loss and a lower percentage of failures, the latter being essential in order to avoid reinterventions that pose an important risks for the elderly patient [12,15,17]. On the other hand, the consolidation rate obtained is high (with only one case of pseudoarthrosis in our series), and with the use of short nails one of the most common complications in endomedullary nailing procedures is diminished: diaphyseal refracture fundamentally associated with the use of long gamma-nails (not seen in our series) [13]. Failure of closed fracture reduction is relatively infrequent, since perfect anatomical reduction is not necessary for implantation, the consolidation can be achieved provided that there is sufficient contact between the bone fragments.…”

Section: Discussionmentioning

confidence: 61%

“…The decision to adopt the Gamma3 Nail as our implant in this type of fractures was based on the findings of last year´s studies between the previous gamma-nail and the Gamma3, in which the Gamma3 afforded the best results [18][19][20][21][22][23][24]. We agree with most authors that the best way to prevent complications is to ensure a careful surgical technique, with special attention to medullary cavity drilling and the manual insertion of the nail [13] In our study we recorded a single cutting phenomenon, in contrast to the 6% rate reported in another series reviewed in our hospital, involving 348 trochanteric fractures treated with the short gamma-nail, and where 37% were A.2 type fractures. This could, in part, be related to an improved surgical technique as well as the increased stability afforded by the long gamma3-nail, due to its lesser leverage and increased length [16].…”

Section: Discussionmentioning

confidence: 97%

“…Few studies have examined the true behavior of intramedullary nails in these fractures, and the existing publications involve a great diversity of nails, thereby complicating interpretation of the results [6][7][8][9][10][11]. Many publications showed good results of former gamma nails to treat proximal fractures [12][13][14][15][16][17]. Recently, with the evolution of the gamma nail many studies published and compared the outcomes of the previous generations with the actual Gamma3 [18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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AO/OTA 31-A2 Fractures: Long or Short Gamma Nail?

Luque¹

2017

BJSTR

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Introduction: The Gamma 3 nail is widely used for AO31A1-3 fractures. The aim of this study was to compare outcomes in patients with 31A2 fractures treated with two lengths of Gamma3 nail. Material:A prospective study of 104 non-pathological 31A2 fractures treated January 2012-January 2014. 14 patients were eliminated due to inadequate follow up. Mean follow-up was 18 months (range 12-36). Average age was 81 years (range 50-99), 78% of the patients were female. We studied two groups: Long Gamma3 Nail (LGN) and Short Gamma3 Nail (SGN). Preoperative variables included: age, medical pathologies, gait, anesthetic risk, associated fractures, hemoglobin and hematocrit values. Postoperatively, we evaluated: functional and radiographic results, quality of life, hemoglobin concentration, hematocrit, transfusion, gait and pain. Intraoperative and postoperative complications were recorded: malunion, nonunion, infection rates, cut-outs and periprosthetic fractures. Results:We obtained a correct reduction in 73% of cases. We found two intraoperative complications (greater trochanteric fractures) in two LGN cases. 38% of the patients with LGN presented nail tip impaction upon the distal anterior femoral cortex, associated with anterior knee pain. Blood loss was statistically different between groups but neither clinical outcomes nor quality of life presented any differences. Conclusion:Our results with these two sizes of the Gamma3 Nail in 31A2 fractures showed no overall differences in clinical outcomes and complication rates. Despite this, the LGN presented a statistically significant higher decrease of the postoperative hematocrit and more transfused blood concentrates. We therefore recommend the use of locked SGN to treat the 31A2 fractures.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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AO/OTA 31-A2 Fractures: Long or Short Gamma Nail?

Luque¹

2017

BJSTR

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“…Although the number of lengths available for long versions would not be suitable for all femurs from the greater trochanter to the condylar notch, the routine use of long IMNs for the fixation of proximal femoral fractures seems logical for splinting the maximum length of the bone. However, the indications for choosing either a standard or long IMN are somewhat unclear and usually subjective [2], and it is unclear whether long nails reduce the rates of reoperation and nonunion.…”

Section: Introductionmentioning

confidence: 99%

Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?

Okçu

Özkayın

Okta

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing.Questions/purposes We compared standard and long types of intramedullary hip nails in terms of (1) reoperation (fixation failure), (2) 1-year mortality rate, (3) function and mobility, and (4) union rate. Methods We conducted a pilot prospective randomized controlled trial comparing standard versus long (C 34 cm) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009. There were 15 patients with standard nails and 18 with long nails. Mean age was 79 years (range, 67-95 years). We determined 1-year mortality rates, reoperation rates, Parker-Palmer mobility and Harris hip scores, and radiographic findings (fracture union, blade cut-out, tip-apex distance, implant failure). Minimum followup was 12 months (mean, 14 months; range, 12-20 months). Results We found no difference in reoperation rates between groups. Two patients (both from the long-nail group) underwent revision surgery because of implant failure in one and deep infection in the other. There was no difference between the standard-and long-nail groups in mortality rate (17% versus 18%), Parker-Palmer mobility score (five versus six), Harris hip score (74 versus 79), union rate (100% in both groups), blade cut-out (zero versus one), and tip-apex distance (22 versus 24 mm). Conclusions Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails.

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“…[13][14][15] Intramedullary nailing to incorporate fixation of the femoral neck and head has advantages, namely shorter operating times and less blood loss, as well as lower rates of infection, non-union, and implant failure. [16][17][18] Plating is still recommended for fractures with proximal trochanteric extension, especially when medial cortical contact can be restored. 3,19,20 We aimed to compare closed intramedullary nailing without anatomic reduction to open reduction and internal fixation using a fixed angle device for subtrochanteric femoral fractures.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary Nailing versus Fixed Angle Blade Plating for Subtrochanteric Femoral Fractures: A Prospective Randomised Controlled Trial

Rahme

Harris

2007

J Orthop Surg (Hong Kong)

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Purpose. To compare closed intramedullary nailingto open reduction and internal fixation using a fixed angle blade plate for the management of subtrochanteric femoral fractures. Methods. 58 patients were equally randomised to undergo either an intramedullary nailing (IN) or fixed angle blade plating (BP). Results. There were no significant differences between the 2 groups with regard to age, time to surgery, operating time, receipt of blood transfusions, duration of hospital stay, or fracture classification. The revision rate was 28% (8/29) in the BP group and none in the IN group; the difference was statistically significant. Conclusion. Internal fixation using a fixed angle blade plate for subtrochanteric femoral fractures has higher implant failure and revision rates, compared to closed intramedullary nailing.

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Intertrochanteric-Subtrochanteric Fractures: Treatment With the Long Gamma Nail

Cited by 113 publications

References 14 publications

AO/OTA 31-A2 Fractures: Long or Short Gamma Nail?

AO/OTA 31-A2 Fractures: Long or Short Gamma Nail?

Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?

Intramedullary Nailing versus Fixed Angle Blade Plating for Subtrochanteric Femoral Fractures: A Prospective Randomised Controlled Trial

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