Treatment of intertrochanteric fracture with the Gamma AP locking nail or by a compression hip screw - a randomised prospective trial

Abstract

The Gamma AP (Asia-Pacific) locking nail (GAPN) is a modification of the standard Gamma locking nail made especially for use in Oriental patients. We made a randomised prospective comparison of the compression hip screw (CHS) and the Gamma AP locking nail for the internal fixation of 60 intertrochanteric fractures of the hip in elderly patients by comparing perioperative details and analysing the radiographic and clinical results. The operation time for the GAPN group was shorter than for the CHS group and the intraoperative blood loss was lower. The Gamma AP nail enabled earlier mobilisation. We found no significant difference in the time to union and the length of sliding of the lag screw between the two groups. The decrease in the neck shaft angle in the Gamma nail group was significantly smaller than in the CHS patients. There were no significant mechanical complications, such as fracture of the femoral shaft or failure of fixation in the Gamma nail group. On the basis of our observations we conclude that the Gamma AP locking nail is more efficient than the CHS in the treatment of intertrochanteric fractures in geriatric patients.

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

“…Using American Board of Orthopaedic Surgery (ABOS) Part II data, Anglen and Weinstein reported that use of IM fixation increased from 3% in 1999 to 67% of cases in 2006 [3]. Numerous studies have been published comparing sliding compression hip screw and side plate with IM fixation [2,12,16,17,29,31,32]. However, results have been contradictory in terms of outcomes [2,12,16,17,29,31,32] with the only consistent differences reported between the two fixation techniques being increased complications (particularly intraoperative and postoperative fractures) and a higher reoperation rate with IMN [4,10,16,29].…”

“…Historically, a sliding hip screw (SHS) has been the preferred implant to stabilize these fractures [5,13,18,21,24,25,35]. However, intramedullary hip screw devices have gained popularity for stabilizing this fracture type [2,4,7,8,10,12,16,17,29,31,32].…”

“…Many of the published studies comparing SHS and IMN for stabilization of intertrochanteric fractures have involved a small number of patients and looked at a limited number of outcomes such as mortality and need for revision surgery [2,4,7,8,10,12,16,17,29,31,32]. Our study, using a large cohort of Medicare beneficiaries, was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized with a SHS or an IMN.…”

The treatment of transtrochanteric fractures of the femur with a minimally invasive technique using an extramedullary implant MINUS System

“…The discussion over the use of intramedullary sliding screws, such as the proximal femur nail (PFN), Gamma Nail versus the extramedullary sliding screw (DHS), is based not only on their stability, which their proponents advocate on the basis of their shorter lever arm [1,2], but also on certain biological advantages that include a reduction of bleeding with the use of smaller incisions [2,15] which, in turn, result in a shorter period of hospital stay and a faster recovery. Several studies have compared intramedullary stems and DHS and have not found significant difference related to operating time, blood loss, consolidation of the fracture and postoperative morbidity [4,9,16].…”

Sistema MINUS® - técnica minimamente invasiva para o tratamento das fraturas transtrocanterianas do fêmur

“…The choice between extra and intramedullary systems is based not only on the stability factor but also on the biological advantage (5,(13)(14)(15)(16) and the final cost of the procedure (16)(17)(18) . …”