Use of the Long Gamma® Nail in Metastatic Fractures and Impending Osteolysis: A Multicenter Experience

Abstract

From 1996toMarch1 999,sixhospitalteams,all of whom were members of the AIOD Francophone,retrospectivelyanalyzed 95 patients treated withanLGN eitherforametastaticfracture orforprophylaxis.Forty-nine patients weretreated att he Centred eTraumatologie in Strasbourg,27 att he CentreHospitaloUniversitaireToulouse-Purpan,seven atthe Hospitalo-UniversitaireLa Cavale Blanche in Brest,eightatthe CentreHospitalierof Dunkerque,a nd four att he HôpitalSaintCamille de Bry sur Marne. Thesep atients werereviewed using the same radiographica nd clinicalcriteria.The surgicaltechniquewasessentiallyidenticalamong all centers. OperativetechniqueThe LGN hasadiaphysealdiameterof 11 mm and ametaphyseal diameterof 17mm. Itisavailable in lengthsranging from 340to 440mm. Three head-neck-shaftanglesareavailable:125,130, and 135 8 .Ithasaradius of curvatureo f2m. Duetothisr adius of curvatureand ananteversion builtintothe system fort he proximalf emur,the nail isavailable in rightand leftconfigurations.The generalprincipalsforthe insertion of the LGN arethe same asthoseforthe standardGammanail and "closed nailing" of the femorald iaphysis:a no rthopaedictable and verification with twoi mage intensifiers arei ndispensable forclosed reduction,a preliminary and absolutelynecessary step beforeanysurgery is done. The entry tothe intramedullary canali st he tip of the greatertrochanter,atthe junction of anteriorone-thirdand posteriort wo-thirds.Reaming iss ystematica nd progressiveupto 17mm,fort he trochantericb odyand the first fewcentimeters of the cavity thatw ill receivethe broadp ortion of the nail,a nd upto1 3mm forthe diaphysealpart.The nail isinserted strictly byhand,in line withthe axisof the femur and using slightrotationalm ovements.The cervical( lag) screws hould bep laced in the medianaxisof the necki nboththe a.p.and lateralviews, avoiding atall costs the superiorquadrantof the head. Its proximaltip isinserted towithin severalm illimeters of the articular AbstractThe long Gamma ® nail (LGN)canbeused when closed,locked intramedullary nailing of the femur isindicated. Its primary applicationsaref orbifocall esions,trochanterica nd diaphyseal fractures,subtrochantericfractures,and trochantero-diaphyseal fractures [3,4,7,8,12,15,20,24,28,36,39].The proximalpart of the femur isafrequentlocation forosteolytic, metastaticlesions. Fixation of the LGN in the femoralhead,along withits intramedullary position and ability tobelocked distallyrecommend itin the treatmentof thesetypesof fractureorforprophylactictreatmentthereof [3,14,32,40].The goalofthe retrospective,multicenterstudydescribed herewastoevaluatethe results and furtherr efine the indicationsfort he LGN in treating osteolyticlesionsof the femur. OriginalArticle 50Downloaded by: WEST VIRGINIA UNIVERSITY. Copyrighted material.

The Use of the Proximal Femoral Nail in the Treatment of Proximal Femur Fractures in the Old Patients

“…Ôèêñàòîðû GN è PFN ïîçâîëÿþò ñòàáèëèçèðîâàòü ïåðåëîìû áåäðåííîé êîñòè îò âåðòåëüíîé çîíû äî ñðåäíåé òðåòè áåäðà [6,9,10]. Îíè ïðèìåíÿþòñÿ äëÿ çàêðûòîãî áëîêèðóþùåãî èíòðàìåäóëëÿðíîãî îñòåîñèíòåçà áåäðåííîé êîñòè.…”