A Comparison of U-blade Gamma3 and Gamma3 Nails Used for the Treatment of Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: To compare outcomes (i.e., clinical and radiological findings, postoperative complication) in the fixation of intertrochanteric fractures with U-blade Gamma3 and Gamma3 nails.MATERIALS AND METHODS: A review of 162 patients (both male and female) treated for intertrochanteric fractures between December 2012 and December 2018 was conducted. All patients were older than 65 years of age and treated with U-blade Gamma3 (n=90) or Gamma3 (n=72) nails. Evaluations included: (i) screw-head position, (ii) fracture-reduction status, (iii) time to union, (iv) cases of cut-out, (v) tip-apex distance, and (vi) lag screw sliding distance. Differences in pre- and postoperative ambulatory ability was also investigated.RESULTS: There were no significant differences in baseline demographics between the two groups. While the lag-screw sliding distance was significantly shorter in U-blade Gamma3 nail group (4.7 mm vs. 3.6 mm; P=0.025), the mean time to union was similar between the groups (P=0.053). Three and six cases of cut-out were noted in the U-blade Gamma3 and Gamma3 nail groups, respectively (P=0.18), however no other postoperative complications were noted in either group. Lastly, there was no difference between the change from pre- to postoperative activity level between the groups (P=0.753).CONCLUSION: Of all the clinical and radiological outcomes assessed, the only significant improvement between those treated with U-Blade Gamma and Gamma3 nails was a shorter lag-screw sliding distance. These findings should benefit clinicians when deciding between the use of U-Blade Gamma or Gamma3 nails.

Clinical Outcomes of U-blade Gamma3 Nails Used to Treat Patients with Trochanteric Fractures: Retrospective Multicenter Study / 대한고관절학회지

PURPOSE: This study was performed to assess the radiologic and clinical results of U-blade Gamma3 nail use for the treatment of trochanteric fractures. MATERIALS AND METHODS: Between September 2015 and May 2018, all patients aged 65 years and older who underwent surgery with U-blade Gamma3 nails were analyzed. A total of 129 patients were selected based on having at least six months of follow-up. Image evaluations included bone quality (T-score), fracture classification on plain radiograph (AO/OTA), computed tomography configuration, union period, position of lag screw, anatomical reduction, tip apex distance (TAD), sliding extent of lag screw, change of neck shaft angle, and complications leading to reoperations were analyzed. Functional outcome were assessed using the Koval grade (ambulatory ability) at the final follow-up. RESULTS: The mean time to union was 19.7 (range, 6–36) weeks. The screw position was centric (93 cases; 72.1%) and anatomical reduction was achieved in 74 cases (57.4%). The mean TAD was 20.3 (range, 12.3–38.1) mm. The mean sliding length of the lag screws was 3.8 (range, 0.1–12.6) mm. The mean change of neck shaft angle was 3.4° (range, 0–12.8°). Reoperations were required in two cases (1.6%) due to the cutting out of the lag screw (n=1) and metal failure with U-blade bending (n=1). Finally, Koval grades for 49.8% of patients reached preoperative status. CONCLUSION: Overall, use of the U-blade Gamma3 nail led to favorable clinical results, suggesting that this system may be a good option for the treatment of trochanteric fractures.

Failure of a Rotation Control Gamma 3 Lag Screw Used to Treat a Trochanteric Fracture / 대한고관절학회지

Gamma 3 rotation control lag screws (U-blade) are particularly useful when treating rotational and unstable fractures of the proximal femur. A 93-year-old woman who underwent closed reduction of a trochanteric fracture and internal fixation with a Gamma 3 nail rotation control lag screw. The patient presented with metal failure and U-blade bending following a fall occurring 4 weeks after surgery. Here, we present a case report summarizing removal of the failed lag screw.

Intrapelvic Penetration of Lag Screw in Proximal Femoral Nailing: A Case Report

Hip fractures are common among elderly individuals. Internal fixation with the intramedullary system has been widely used to treat intertrochanteric femur fractures. The Gamma 3 nail is a useful device for fixating trochanteric fractures of the proximal femur. We report a rare complication of medial pelvic penetration of the lag screw of a Gamma 3 nail two months after surgery. There was a complete separation between the nail body and lag screw, and the lag screw penetrated through the acetabulum into the pelvis. We report a case of unstable intertrochanteric fracture with intrapelvic penetration after surgical treatment with proximal femoral nailing and a case followed by fatal results.

Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail

PURPOSE: To compare the result between the third generation gamma nail (gamma 3 nail) and proximal femoral nail anti-rotation (PFNA) in the treatment of unstable intertrochanteric fractures. MATERIALS AND METHODS: Between March 2009 and June 2011, 47 consecutive patients with unstable intertrochanteric femoral fractures were treated with gamma 3 nail or PFNA. We reviewed 24 cases of gamma 3 nail and 23 cases of PFNA. Retrospectively, we evaluated the mean operation time, amount of bleeding, average union period, reduction status, change of neck shaft angle, Tip-apex distance, Cleveland index, sliding of lag screw and complication on set of telephone interview and outpatient. We also evaluated the postoperative capability of function and mobility, using 'Modified Koval index'. RESULTS: There were no significant differences between the groups, which were treated with gamma 3 nail and PFNA. In addition, they did not show statistical difference. We experienced 2 cases of complication (gamma 3 nail 1 case, PFNA 1 case), which were cut-out of the femoral head. CONCLUSION: The gamma 3 nail and PFNA were seen with good results in the treatment of unstable intertrochanteric fracture.

The Antero-medial Cortex Overlapped Reduction of Unstable Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: The purpose of this article is to evaluate the result of treatment of unstable intertrochanteric fractures by lateralization of distal fragment and antero-medial cortex contact of the distal shaft piece. MATERIALS AND METHODS: We conducted an analysis of 20 cases of unstable intertrochanteric fractures treated using a gamma-3 nail from August 2011 to August 2012 and followed up for more than one year. Using postoperative and last follow-up radiographs, we measured NSA, TAD, Cleveland index, sliding length of the lag screw, and union time. Adequacy of reduction was assessed by a modification in the criteria of Baumgaertner and classified as good, acceptable, or poor. RESULTS: The mean NSA was 140degrees postoperative and 135degrees at last follow-up. The mean TAD was 11.3 mm. The position of the lag screw was in center-center in 12 cases, center-inferior in eight cases. The mean distance of lag screw sliding was 5.5 mm at last follow-up. The mean union time was 3.7 months. The state of reduction postoperatively was good in 15 cases, and acceptable in five cases. There was no failure of reduction, lag screw cut-out, or other complications at last follow-up. CONCLUSION: The reduction method for lateralization of distal fragment and antero-medial cortex contact of the distal shaft piece in an unstable intertrochanteric fracture is very useful for prevention of collapse of the fracture site, lag screw cut-out, and mechanical failure.

Comparison of the Dyna Locking Trochanteric Nail, Proximal Femoral Nail Antirotation and Gamma 3 Nail in Treatment of Intertrochanteric Fracture of the Femur / 대한고관절학회지

PURPOSE: The purpose of this study is to compare and analyze the radiological and clinical results after treatment of intertrochanteric fractures of the femur by three devices including DLT, PFNA and Gamma 3 nail. MATERIALS AND METHODS: From January 2007 to January 2012, we reviewed 131 patients who suffered intertrochanteric fractures(33 cases of DLT, 59 cases of PFNA, 39 cases of Gamma 3 nail). The following were measured for all three groups; The tip apex distance (TAD), neck shaft angle and lag screw position at the head of femur, as well as the amount of blood loss and transfusion, operation time, duration of hospitalization and postoperative ICU admission, complications were also assessed. RESULTS: In comparison of the radiological results, there were no statistical differences among the three groups in TAD, neck shaft angle and the lag screw position. There was no statistical difference in clinical results. In the last follow-up, there was one case of nonunion in the PFNA group. There also was, in the last follow up, a development of varus angulation & cut-out of lag screw that occurred in 2 cases (DLT), 4 cases (PFNA), 1 cases (Gamma 3). There was no statistical difference among the three groups in the sliding length of the lag screw. CONCLUSION: Any certain group was not better than the others with regard to the radiological and clinical results among DLT, PFNA and Gamma nail groups in treating intertrochanteric fracture. To achieve favorable results, precise reduction of fracture site and surgical techniques are important.

Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture

PURPOSE: To evaluate clinical and radiological results of surgical treatment of femur intertrochantenric fracture using Gamma 3 nail. MATERIALS AND METHODS: With clinical study, 22 patients who were treated surgically by Gamma 3 nail were retrospectively evaluated. By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Neck-shaft angle change Lag screw slippage and Union time. And By medical record review, the clinical results were evaluated with the operation time, intraperative estimated blood loss, amount of transfusion, change of mobility and complication. RESULTS: The mean change of femur neck shaft angle was 5.18 degrees. The mean lag screw sliding was 5.43 mm. The mean bone union time was 11.8 weeks. From all of these examples shows bone union. The mean operative time was 41 min, blood loss was 161 ml and the transfusion amount was 0.3 pint. In Ceder et al mobility score, it showed 0.2 point decreased and in Jensen social function score, it showed 0.6 point increased. Comparing the results before and after operation, the results were satisfactory. CONCLUSION: Using the Gamma 3 nail, the treatment of fermur intertrochanteric fractures showed good results both radiologically and clinically.