Migration of the Lag Screw after Intramedullary Treatment of AO/OTA 31.A2.1-3 Pertrochanteric Fractures Does Not Result in Higher Incidence of Cut-Outs, Regardless of Which Implant Was Used: A Comparison of Gamma Nail with and without U-Blade (RC) Lag Screw and Proximal Femur Nail Antirotation (PFNA)

Abstract

The best intramedullary nail for the treatment of unstable AO/OTA 31.A2.1-3 fractures remains uncertain. A total of 237 patients (45 male, 192 female) were eligible for the assessment with an average age of 81.9 ± 10.5 years and a minimum follow-up of six months. We assessed the cut-out rate, the TAD and calTAD (Tip Apex distance) of three different implants. An overall cut-out rate of 2.5% (n = 6) was observed. The cut-out rate was 1.2% (n = 1) in the Proximal Femur Nail Antirotation (PFNA) group, 3.7% (n = 3) in the Gamma Nail group and 2.9% (n = 2) in the Gamma3® with a U-Blade (RC) lag-screw group. The TAD and calTAD differed between the cut-out and non-cut group—20.0 mm vs. 18.5 mm and 13.1 mm vs. 15.3 mm, respectively. A significantly higher TAD of 32.5 mm could be seen in the cut-out after PFNA (p < 0.0001). The only significant change in follow-up using Parker’s ratio was observed in the PFNA group (p < 0.0001). The rate of patients requiring surgery after complications was 8.4% (n = 20) without any significant difference between the three groups. The PFNA blade showed significant migration within the femoral head, however the cut-out rate remained the smallest compared to Gamma3 with or without additional U-Blade (RC) lag screw.

A Comparison of Dynamic Hip Screw and Two Cannulated Screws in the Treatment of Undisplaced Intracapsular Neck Fractures—Two-Year Follow-Up of 453 Patients

“…The frequency of age-associated bone fractures is expected to rise as life expectancy continues to increase [2]. The principle factor responsible for this trend is the age-related bone demineralisation of the proximal femur compounded by the high prevalence of vitamin D deficiency [3]. Furthermore, these changes are compounded by the higher rates of falls among the elderly [4].…”

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

“…www.nature.com/scientificreports www.nature.com/scientificreports/ the additional U-Blade lag screw reduced the cut-out rate compared with the standard lag screw (2.2% vs. 3.7%). In addition, they found that the cut-out rate in PFNA remained the smallest (1.2%) compared with Gamma3 with or without an additional U-Blade lag screw, although the PFNA showed significant migration within the femoral head 32 . However, they did not describe and compare the BMD, details of fracture patterns such the presence of a basicervical component and comminution of the anterior cortex, and quality of reduction, which can affect fixation failures such as cut-out.…”

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

“…Both RoSA and the Gamma-RC hip screw systems have proved to increase significantly the migration resistance compared with single screw systems [5,8,11,12] . However, the clinical results, mainly presented by retrospective studies, did not show a conclusive picture in this regard to date [13][14][15] .…”