Nailing unstable pertrochanteric fractures: does size matters?
Comparative study
Fracture fixation
Hip fractures
Intramedullary
Intramedullary nailing
Trochanteric fractures
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
05
06
2020
accepted:
15
10
2020
pubmed:
5
11
2020
medline:
8
1
2022
entrez:
4
11
2020
Statut:
ppublish
Résumé
New generation cephalomedullary nails are, currently, widely used for the treatment of trochanteric proximal femoral fractures. This study aims to compare the midterm outcomes and complication rates in patients with unstable 31A2 fractures treated with two different lengths of nails. Retrospective study including 123 pertrochanteric proximal femoral fractures 31A2 treated with Gamma3 nail A correct radiological fracture reduction was obtained in 73% of the cases (73% SGN/74% LGN). Two patients in LGN group had intraoperative complications (greater trochanter fractures). 38% of the patients with LGN presented nail tip impaction upon the distal anterior femoral cortex, associated with anterior knee pain. Blood loss and operative time was statistically different between groups. Despite the previous, no differences in clinical outcomes and quality of life were found. The present study comparing two lengths of the Gamma3 Nail in 31A2 fractures showed no overall differences in clinical and radiological outcomes, and complication rates. However, the use of LGN was associated with a statistically significant higher blood loss and operative time, and a tendency for increased need for transfusion, and anterior knee pain and reoperation rate. Therefore, we recommend the use of locked SGN in the treatment of 31A2 fractures.
Identifiants
pubmed: 33146752
doi: 10.1007/s00402-020-03668-0
pii: 10.1007/s00402-020-03668-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
145-155Informations de copyright
© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Guo X, Zhang K, Fu H, Cao W, Dong Q (2015) Original article A comparative study of the therapeutic effect between long and short intramedullary nails in the treatment of intertrochanteric femur fractures in the elderly. Chin J Traumatol 18(6):332–335
doi: 10.1016/j.cjtee.2015.12.001
Boone C, Carlberg KN, Koueiter DM, Baker KC, Sadowski J, Wiater PJ et al (2014) Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31-A1 and A2). J Orthop Trauma 48073:96–100
doi: 10.1097/BOT.0b013e3182a7131c
Horner NS, Samuelsson K, Solyom J, Ayeni OR, Ostman B (2017) Implant-related complications and mortality after use of short or long gamma nail for intertrochanteric and subtrochanteric fractures. J Bone Joint Surg 2(3)
Bovbjerg PE, Larsen MS, Madsen CF (2019) Schnnemann failure of short versus long cephalomedullary nail after intertrochanteric fractures. J Fract J Orthop. https://doi.org/10.1016/j.jor.2019.10.018
Kleweno C, Morgan J, Redshaw J et al (2014) Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. J Orthop Trauma 28(7):391–397. https://doi.org/10.1097/BOT.0000000000000036
doi: 10.1097/BOT.0000000000000036
pubmed: 24231580
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170. https://doi.org/10.1097/BOT.0000000000001063
doi: 10.1097/BOT.0000000000001063
Vicario C, Marco F, Domínguez I, López-Durán L (2000) Tratamiento en el anciano de las fracturas de la región trocantérea femoral con clavo intramedular gamma. Rev Ortop Traumatol 5:434–438
Vicario C, Marco F, Ortega L, Alcobendas M, Dominguez I, López-Durán L (2003) Necrosis of the femoral head after fixation of trochanteric fractures with Gamma Locking Nail. A cause of late mechanical failure. Injury 34(2):129–134. https://doi.org/10.1016/s0020-1383(02)00171-7
doi: 10.1016/s0020-1383(02)00171-7
pubmed: 12565020
Parker MJ (1996) Trochanteric hip fractures. Fixation failure commoner with femoral medialization, a comparison of 101 cases. Acta Orthop Scand 67(4):329–332. https://doi.org/10.3109/17453679609002325
doi: 10.3109/17453679609002325
pubmed: 8792733
Parker MJ (2000) Handoll HH Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev 2:293–299
Chinzei N, Hiranaka T, Niikura T, Tsuji M, Kuroda R, Doita M, Kurosaka M (2015) Comparison of the sliding and femoral head rotation among three different femoral head fixation devices for trochanteric fractures. Clin Orthop Surg. 7(3):291–297
doi: 10.4055/cios.2015.7.3.291
Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ (2010) A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am 92(4):792–798. https://doi.org/10.2106/JBJS.I.00508
doi: 10.2106/JBJS.I.00508
pubmed: 20360500
Baumgaertner MR, Curtin SL, Lindskog DM (1998) Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res 348:87–94
doi: 10.1097/00003086-199803000-00015
Dunn J, Kusnezov N, Bader J, Waterman BR, Orr J, Belmont PJ (2016) Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review. J Orthop Traumatol. 17(4):361–367. https://doi.org/10.1007/s10195-016-0405-z
doi: 10.1007/s10195-016-0405-z
pubmed: 27093971
pmcid: 5071234
Michael D, Yaniv W, Tal FR et al (2016) Expandable proximal femoral nail versus gamma proximal femoral nail for the treatment of AO/OTA 31A1-3 fractures. Injury 47(2):419–423. https://doi.org/10.1016/j.injury.2015.10.013
doi: 10.1016/j.injury.2015.10.013
pubmed: 26573896
Andreani L, Bonicoli E, Piolanti N et al (2015) Prospective randomized controlled trial of two different intramedullary nails for pertrochanteric fractures of the femur. Surg Technol Int. 27:210–214
pubmed: 26680399
Chang SM, Zhang YQ, Ma Z, Li Q, Dargel J, Eysel P (2015) Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg 135(6):811–818. https://doi.org/10.1007/s00402-015-2206-x
doi: 10.1007/s00402-015-2206-x
pubmed: 25840887
pmcid: 4436685
Xu Y, Geng D, Yang H, Wang X, Zhu G (2010) Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3. Orthopedics 33(7):473. https://doi.org/10.3928/01477447-20100526-03
doi: 10.3928/01477447-20100526-03
pubmed: 20608635
Winnock de Grave P, Tampere T, Byn P, Van Overschelde J, Pattyn C, Verdonk R. Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. A prospective randomised clinical trial. Acta Orthop Belg. 2012;78(2):192‐198
Ceder L (2000) The difficult extracapsular hip fracture (including subtrochanteric). Curr Orthopaedics. 14(2):93–101. https://doi.org/10.1054/cuor.2000.0094
doi: 10.1054/cuor.2000.0094
Shetty A, Shenoy PM, Swaminathan R (2019) Mismatch of long Gamma intramedullary nail with bow of the femur: does radius of curvature of the nail increase risk of distal femoral complications? J Clin Orthop Trauma. 10(2):302–304. https://doi.org/10.1016/j.jcot.2017.12.006
doi: 10.1016/j.jcot.2017.12.006
pubmed: 30828198
Zhang Y, Zhang S, Wang S et al (2017) Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review and meta-analysis. Orthop Traumatol Surg Res. 103(5):685–690. https://doi.org/10.1016/j.otsr.2017.04.003
doi: 10.1016/j.otsr.2017.04.003
pubmed: 28546048
Vaughn J, Cohen E, Vopat BG, Kane P, Abbood E, Born C (2015) Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up. Eur J Orthop Surg Traumatol 25(4):665–670. https://doi.org/10.1007/s00590-014-1557-2
doi: 10.1007/s00590-014-1557-2
pubmed: 25337958
Barquet A, Francescoli L, Rienzi D, López L (2000) Intertrochanteric-subtrochanteric fractures: treatment with the long Gamma nail. J Orthop Trauma 14(5):324–328. https://doi.org/10.1097/00005131-200006000-00003
doi: 10.1097/00005131-200006000-00003
pubmed: 10926238
Pervez H, Parker MJ (2001) Results of the long Gamma nail for complex proximal femoral fractures. Injury 32(9):704–707. https://doi.org/10.1016/s0020-1383(01)00022-5
doi: 10.1016/s0020-1383(01)00022-5
pubmed: 11600117
Anchuela J, Carretero R, San Martín A et al (2002) El clavo Gamma largo en las fracturas extracapsulares del fémur. Rev Ortop y Traumatol. 6:234–238
Li Z, Liang Y, Zhao C, Wu H (2014) Zhonghua Yi Xue Za Zhi. 94(43):3436–3438
pubmed: 25622678
Heiney J, Battula S, Njus G, Ruble C, Vrabec G (2008) Biomechanical comparison of three second-generation reconstruction nails in an unstable subtrochanteric femur fracture model. Proc Inst Mech Eng H. 222(6):959–966. https://doi.org/10.1243/09544119JEIM369
doi: 10.1243/09544119JEIM369
pubmed: 18935812
López-Vega M, Gil-Monzó ER, Rodrigo-Pérez JL et al (2015) Estudio prospectivo aleatorizado sobre la influencia del bloqueo distal del clavo Gamma 3 en el tratamiento de las fracturas pertrocantéreas de fémur [Randomized prospective study on the influence distal block and Gamma 3 nail on the treatment of intertrochanteric fractures of femur]. Rev Esp Cir Ortop Traumatol. 59(1):26–35. https://doi.org/10.1016/j.recot.2014.06.004
doi: 10.1016/j.recot.2014.06.004
pubmed: 25088240
Mingo-Robinet J, Torres-Torres M, Martínez-Cervell C et al (2015) Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases. J Orthop Trauma 29(3):e85–e90. https://doi.org/10.1097/BOT.0000000000000190
doi: 10.1097/BOT.0000000000000190
pubmed: 24983431
Huang H, Xin J, Ma B. Analysis of complications of intertrochanteric fracture treated with Gamma 3 intramedullary nail. Int J Clin Exp Med. 2014;7(10):3687‐3693. Published 2014 Oct 15
Georgiannos D, Lampridis V, Bisbinas I (2014) Complications following Treatment of Trochanteric Fractures with the Gamma3 Nail: is the Latest Version of Gamma Nail Superior to Its Predecessor? Surg Res Pract. 2014:143598. https://doi.org/10.1155/2014/143598
doi: 10.1155/2014/143598
pubmed: 25374946
pmcid: 4208494
Kempf I, Grosse A, Taglang G, Favreul E (2014) Gamma nail in the treatment of closed trochanteric fractures Results and indications of 121 cases. Orthop Traumatol Surg Res. 100(1):75–83. https://doi.org/10.1016/j.otsr.2013.12.013
doi: 10.1016/j.otsr.2013.12.013
pubmed: 24456767
Westacott D, Bould M (2011) Outcome in 36 elderly patients treated with the Gamma3 Long Nail for unstable proximal femoral fracture. Acta Orthop Belg 77(1):68–72
pubmed: 21473448