A clinical study on the relationship of the tail femur distance and the lag screw migration or cutting-out after the third generation of Gamma nail fixation of intertrochanteric fracture / 中国修复重建外科杂志

Objective: To confirm the association between tail femur distance (TFD) and lag screw migration or cutting-out in the treatment of intertrochanteric fracture with the third generation of Gamma nail (TGN).

Comparative study of proximal femoral shortening after the third generation of Gamma nail versus proximal femoral nail anti-rotation in treatment of intertrochanteric fracture / 中国修复重建外科杂志

Objective: To explore the difference of the proximal femoral shortening (PFS) between the third generation of Gamma nail (TGN) and the proximal femoral nail anti-rotation (PFNA) in treating intertrochanteric fracture of femur.

Breakage of a Lag Screw of Cephalomedullary Nail: A Technique of Removal

A broken lag screw of the cephalomedullary nail is a rare condition. Removal of the retained lag screw from the femoral head is also very challenging. This article describes a surgical technique and the modified instrument that was available in the operating room for removing the broken implant by closed technique.

Efficacy of PFNA and Gamma nail in treatment of intertrochanteric fractures in elderly / 局解手术学杂志

Objective to observe the efficacy and application value of PFNA and Gamma in the treatment of intertrochanteric fractures in elderly. Methods 100 patients with intertrochanteric fractures were divided into PFNA group and Gamma group, who received PFNA treatment and Gamma treatment respectively. And the operation status of patients at different ages,postoperative recovery,and complications were observed. Results The operation time,intraoperatve blood soss of PFNA group were lower than those of Gamma group(P<0. 05). There was no significant difference in fracture healing time. The Harris score of the over 75s in PFNA group was higher than that in Gamma group(P<0. 05),and the complications were less than Gamma group(P<0. 05). Conclusion PFNA was suitable for the patients at differ-ent ages with the advantages of more rigid fixation,good anti-rotation,fewer trauma and fewer complications.

Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures

PURPOSE: This study was conducted in order to demonstrate the radiologic and clinical results of using the Asian type gamma 3 nail in treatment of trochanteric fractures. MATERIALS AND METHODS: Patients underwent operations with gamma 3 nails between August 2010 and August 2012. For the radiologic evaluation, we analyzed bone quality, fracture pattern, reduction quality, union period, and position of lag screw (tip-apex distance, Cleveland index). For the clinical evaluation, we analyzed mobility score of Palmer and Parker and Jensen's functional score. RESULTS: The mean union was taken at 17.4 weeks (14-25 weeks). Two cases (4.3%) underwent reoperation due to cutting out of the hip screws. The clinical outcomes of Parker and Palmer's average mobility score changed from 7.3 to 5.8 (79%), Jensen's functional score was 1.3 to 1.8 (72%). CONCLUSION: We achieved excellent clinical and radiological outcomes; therefore, Asian type gamma 3 nail is effective in treatment of trochanteric fractures of the femur in Korea.

Comparison of the Radiologic Outcomes following the Kinds of Implants in Treating Unstable Osteoporotic Intertrochanteric Fracture / 대한골다공증학회지

OBJECTIVES: To determine whether kinds of implants would influence on the radiologic outcomes in the treatment of unstable osteoporotic intertrochanteric fractures. MATERIALS AND METHODS: In this retrospective study, radiologic outcomes of 151 patients with unstable osteoporotic intertrochanteric fractures undergoing surgical treatments were compared based on the types of fixation implants as follows : PFNA (53 cases, group I), gamma nail 3(31 cases, group II), CHS with TSP (43 cases, group III), and helical blade type LCP-DHS with TSP (24 cases, group IV). On the follow-up radiographs after operations, we assessed differences of bone union durations, neck-shaft ankle changes, lag screw or helical blade slippages, and varus alpha angle changes among the study groups. RESULTS: All the radiologic outcomes evaluated in this study were not significantly different among the study groups. The average bone union durations of the group I, II, III and IV were 17.7, 18.0, 18.2, and 17.8 weeks, respectively (P=0.429). The average variation of neck-shaft angle of the group I, II, III and IV were 3.6degrees, 3.1degrees, 3.7degrees and 2.9degrees, respectively (P=0.273). The average lag screw or blade slippage of the group I, II, III and IV were 5.1 mm, 3.3 mm, 3.6 mm and 2.7 mm, respectively (P=0.154). The average variation of varus alpha of the group I, II, III and IV were 5.3degrees, 4.7degrees, 4.1degrees and 4.6masculine, respectively (P=0.894). CONCLUSIONS: This study indicates that four typical types of fixation implants for treating unstable osteoporotic intertrochanteric fractures would not lead to differences in postoperative radiological outcomes.

The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail

PURPOSE: To evaluate the efficiency of additional fixation of the alternative bone substitute in unstable intertrochanteric fractures treated with gamma nail and alternative bone substitute and only with gamma nail. MATERIALS AND METHODS: Radiologic comparison was done between forty-four patients of unstable intertrochanteric fracture (AO type A2.2, A2.3) during six months. The patients were divided into two groups, a group treated with gamma nail and alternative bone substitute (22 patients, group 1) and another group treated only with gamma nail (22 patients, group 2). Postoperative reduction status, Cleveland index, Tip-apex distance and complications during the follow-up period was compared. Lag screw slippage and femoral neck-shaft angle change were measured between two groups. RESULTS: No significant difference of reduction status, Cleveland index and Tip-apex distance was found. In group II, there was a 1 more case of cutting-out of the lag screw, but also there was a significant difference. Lesser change in lag screw slippage and neck-shaft angle change was investigated. CONCLUSION: As there are lesser lag screw slippage and neck-shaft angle change, alternative bone substitutes applied in unstable intertrochanteric fractures seems to be useful in maintaining reduction and preventing failure of internal fixation when proper reduction and screw insertion is performed.

Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

PURPOSE: We analyzed the complications of femoral peritrochanteric fractures treated with the Gamma nail to reduce its complications. MATERIALS AND METHODS: We evaluated the complications among the 96 patients who were treated with the Gamma nail from January 2000 to May 2005. Mean follow-up period was 17.8 months and mean age was 75.2 years. We analysed the relationship between the complication and the fracture pattern, postoperative reduction status, position of the lag screw, bone density, displacement and tip-apex index (TAD). RESULTS: The complications were presented in 12 cases (12.5%). Cut-out of lag screw were in 5 cases, varus deformity with short lag screw in 2 cases, metal breakage of distal screw in 1 case, breakage of drill bit intraoperatively in 1 case, superficial infection in 2 cases and deep infection in 1 case. 5 cases (4.2%) were required reoperation. All of the cut-out of lag screw showed increased TAD (tip apex distance) above 25 mm. CONCLUSION: To reduce the complications of the Gamma nail, we need exact surgical technique, good positioning of the lag screw and choice of appropriate length for the lag screw.

Classification and Treatment of Unstable Intertrochanteric Fracture according to the Existence of Posterior Fragment : Preliminary Report

PURPOSE: To predict the feature and stability of intertrochanteric fractures with posterior fragment using preoperative 3D computed tomography and to investigate the importance of the posterior fragment in treatment of unstable intertrochanteric fracture. MATERIALS AND METHODS: 15 cases of unstable fractures with posterior fragment which were treated with nail only between October 2006 to August 2007 were classified into 2 groups: study group (5 cases with cannulated screw fixation of posterior fragment) and control group (10 cases without cannulated screw fixation). The average difference of neck-shaft angle, neck screw sliding distance and the complications in the two groups were compared retrospectively after a follow up of at least 3 months. RESULTS: The average difference of neck-shaft angle in study and control group was 3.8 and 7.5 degree (p>0.05), respectively. The average difference of neck screw sliding distance was 1.6 and 6.6 mm (p<0.05), respectively. Complication which required reoperation was not noted in study group and complications of 3 cases about neck screw lateral protrusion, proximal migration and Z-effect phenomenon were noted in control group. CONCLUSION: The recognition and fixation of the posterior wall was found to be an important predictive factor in unstable intertrochanteric fracture treatment.

Comparison of the Gamma Nail and the Proximal Femoral Nail in the Treatment of Intertrochanteric Fracture

PURPOSE: We wanted to evaluate the results of fracture fixation with using Gamma nails and Proximal Femoral Nails (PFN) for treating intertrochanteric fractures. MATERIALS AND METHODS: From January 2003 to December 2005, we reviewed 77 patients who suffered with intertrochanteric fractures (35 cases of Gamma nails and 42 cases of PFNs). We evaluated the intraoperative blood loss, the operation time, the presence of stable reduction and the varus reduction rate, the union time, cutting-out, the screw head position, the status of the fracture reduction and the complications. The pre- and post-operative difference in the patients' ambulatory ability was also investigated. RESULTS: The mean operation time with using Gamma nails was shorter and the screw with using Gamma nails was located more centrally than that with using PFNs. The other factors were not statistically different. Cutting-out was not noted with Gamma nails, but 2 cases of cutting out were noted with using PFNs. 8 cases of proximal migration were noted with Gamma nails and 6 cases of lateral protrusion of the proximal pin were noted with using PFNs. CONCLUSION: The Gamma nail for which a single lag screw was inserted centrally had no case of cutting-out, which was in contrast to using PFNs for which two lag screws were used, although there was no statistically significant difference. In addition to this, the shorter operative time makes Gamma nails more appropriate for the operative treatment of femoral intertrochanteric fracture.

Comparison of anatomical dynamic hip lock plate and Gamma nail for the treatment of unstable intertrochanteric femoral fractures / 中国矫形外科杂志

[Objective] To compare anatomical dynamic hip lock plate with Gamma nail internal fixation in terms of the early intermediate clinical effect of the unstable intertrochanteric femoral fractures. [Methods]From January 2003 to August 2008, 69 patients with unstable intertrochanteric femoral fractures were fixed with plate (n=34)and Gamma nail(n=35).They were randomized into two treatment groups.A retrospective comparison was made between the two differet fixation devices in terms of operation time,blood loss,intraoperative and postoperative complications,frequency of exposure to X-ray,healing time of fracture and functional recovery of hip-joint.[Results]Comparing with Gamma nail,cases with anatomical dynamic hip lock plate experienced fewer X-ray during operation and had fewer postoperative complications,and the differences had statistical significance(P

Comparison of effect of standard Gamma nail and proximal femoral nail anti-rotation for geriatric intertrochanteric fractures / 中国矫形外科杂志

[Objective]To investigate and compare the effects of standard gamma nail (SGN) and proximal femoral nail anti-rotation (PFNA) in the treatment of osteoporotic intertrochanteric fractures in the elderly.[Method]From May 2002 to September 2005,55 patients with intertrochanteric fractures were treated with SGN.Sixty-eight patients were treated with PFNA from November 2005 to June 2008.The effects of the two implants about perioperative complications,bone healing and the function of the operated hip joint were compared.[Result]No statistically significant difference was found between the two groups in blood loss,blood transfusion,infection,deep venous thrombosis and hospital stay.One patient developed femoral head avascular necrosis postoperatively in Gamma nail group.The incidence of postoperative hip pain in Gamma nail group was higher than that in the PFNA group,but there was no significant difference in the Harris score.[Conclusion]Gamma nail and PFNA nail are reliable methods to treat geriatric intertrochanteric fractures,with advantages of minimal iatrogenic injury,stable fixation and few complications.

A comparative study of Gamma nail and proximal femoral nail in treatment of intertrochanteric fractures of femur / 中华创伤骨科杂志

Objective To compare the clinical results of the intramedullary nails (Gamma nail and the proximal femoral nail) in treatment of intertrochanteric fractures of femur. Methods A review study was conducted on 116 intertrochanteric fractures of femur treated with the Gamma nail and 89 treated with PFN in our hospital between 2000 and 2003. Results In the Gamma nail group, the mean time for operation was 68.3(48 to 106)minutes,the mean blood loss during operation was 261(180 to 400)mL,the mean time for walking after operation was 5.0 (2.3 to 8.9)weeks and the mean time for bone union was 8.6(7.1 to 12.6)weeks. In the PFN group, the mean time for operation was 48.0(36 to 85)minutes, the mean blood loss during operation was 192(120 to 360)mL,the mean time for walking after operation was 5.3(2.5 to 8.1)weeks and the mean time for bone union was 8.8(6.9 to 12.1)weeks. There were significant differences in the mean time for operation and the mean blood loss between the 2 groups(P

Intramedullary fixation of trochanteric fractures with fluoro-navigation / 中华创伤骨科杂志

Objective To illustrate the application of fluoronavigation in Gamma nailing—a common surgical procedure in treatment of intertrochanteric fracture of femur and to compare the newly designed Gamma-3 system for navigation with the Gamma-AP system. Methods 66 patients with intertrochanteric fractures underwent Gamma nailing (40 Gamma-AP and 26 Gamma-3) under fluoronavigation guidance. An observer recorded the different intra-operative parameters. Results The Gamma-3 group showed superior results of shorter operation time (averaging 32 minutes), smaller surgical wound size (5cm), less X-ray requirement during procedure (7 times) and at the same time better lag screw position (Tip-Apex-Distance 17.9 mm). Conclusions Fluoronavigation can facilitate gamma nailing as a minimally invasive surgery because of its accurate guidance to nail insertion and lag screw positioning, a smaller surgical wound and minimized X-ray exposure suffered by operation theater staff. The Gamma-3 system has shown better results than the Gamma-AP system because of its navigation-specific design.

Comparison between Gamma nail and DHS/Richard in treatment of proximal femoral fracture: a meta analysis / 中华创伤骨科杂志

Objective To asses the effects of Gamma nail and DHS/Richard (dynamic hip screw) in the treatment of proximal femoral fractures. Methods A meta analysis of all the relevant randomized controlled trials (RCTs) was performed. We included randomized and quasi randomized controlled trials in patients with proximal femoral fracture to compare Gamma nail and DHS/Richard. Results First we identified 88 papers on comparison of Gamma nail and DHS/Richard in the treatment of proximal femoral fractures published from 1969 to 2003. 7 trials involving 1256 patients were identified as meeting all the eligibility criteria. 3 investigators independently graded study quality and abstracted relevant data, including information on mortality rates, wound infection, function, revision in patients with a proximal femoral fracture. 4 trials, which included a total of 621 patients, provided detailed information on mortality rates over the first 6 postoperative months. We found there was no significant difference in the relative risk of death in the first 6 months postoperative between treatments of Gamma nail and those of compression hip screw (relative risk 1.17;P=0.51). 6 trials that included a total of 1083 patients provided data on operative complications. The risk of operative complications from Gamma nail fixation appeared to be higher than that from compression screw and side plate fixation but not higher than that from compression hip screw (relative risk 1.41; P=0.02). We also found an obvious increase in the relative risk of fracture of femoral shaft between Gamma nail and compression hip screw (relative risk 6.99; P=0.00). Patients treated with Gamma nail had a higher rate of revision compared with those with compression hip screw, but there was no significant difference between the two groups (relative risk 1.85; P=0.20). In addition, wound infection, operative blood loss and functional recovery were similar between the tow groups(relative risk 0.98 for wound infection and 1.02 for function). Operating time for Gamma nail patients was significantly less than that for DHS/Richard ones (P

Nailing in the Patients with Intertrochanteric Fractures of the Femur: Comparision Gamma Nail and Proximal Femoral Nail

PURPOSE: To evaluate the clinical and radiologic results of the fracture fixation using the Proximal Femoral Nail (PFN) or Gamma nail in patient with the intertrochanteric fractures. MATERIALS AND METHODS: From January 1999 to February 2002, we reviewed 63 patients of intertrochanteric fractures including 31 patients managed with Gamma nail and 32 patients with PFN. In variate analysis of age, the pattern and stability of fracture, bone density (Singh index), preoperative patient activity, there was no difference between two groups. We evaluated the operation time, blood loss, stable reduction rate and varus reduction rate as operation-related factors, and radiologically investigated union time, the frequency of delayed union and nonunion, failure of fixation, status of the fracture line and complications. Functional results were evaluated by the possibility of early ambulation, ambulation ability at last follow up, and the pre and postoperative difference of ambulatory ability. RESULTS: Mean operation time was 103+/-40 minutes in Gamma nail group and 101+/-28 minutes in PFN group. It was not statistically significant (p=0.801). Even though intraoperative blood loss was less in PFN group, it was not significant (p=0.601). Postoperative stable reduction rate was 31% in Gamma nail group and 30% in PFN group (p=0.934), suggesting not significant. Postoperative varus reduction and impacted amount of the fracture line was not significant. Delayed union developed in one case of Gamma nail group and 2 cases of PFN group. Mean loss of ambulation ability was 1.28 grade in Gamma nail group and 0.86 grade in PFN group (p=0.383). Statistical analysis was performed with the use of Student T test and Chi-square test. Analyses resulting in a p value of <0.05 were considered to show significance. CONCLUSION: Generally, the radiologic and clinical results of intertrochanteric fractures were comparable for the PFN group and Gamma nail group. Even though it was not statistically significant, PFN group had superior results in operation time and blood loss than Gamma nail group for the fixation of the patients with intertrochanteric fracture.

Peritrochanteric Fractures of The Femur Treated with Gamma Nail / 대한정형외과학회잡지

PURPOSE: To analyze clinical and radiologic results and to identify the relevant factors indicating the cutting out of lag screw for the treatment of peritrocanteric fracture of the femur using a gamma nail. MATERIALS AND METHODS: Eighty-three peritrochanteric fractures, by the Evans classification, were evaluated clinically to assess the walking capacity. Radiologically bone union, reduction status, sliding, position of the lag screw, bone density, displacement, and tip-apex index (TAD) were evaluated. The relationship between the cutting out of lag screw and the relevant factors such as age, osteoporosis, sliding of lag screw, TAD, fracture stability were analyzed. RESULTS: Time to union averaged 14.1 weeks in stable fractures and 21.5 weeks in unstable fractures. Acceptable reduction was available in 75 (91.5%) cases. Superior-anterior positioning of the lag screw was only found in 3 (3.4%) cases. Average sliding of the lag screw was 3.9 mm. Mean proximal protrusion of the nail was 4.8 mm, and mean TAD was 25.29 mm. Cutting-out was occurred in 9 (10.8%) cases. Sliding (>10 mm) and TAD (>25 mm) were related significantly to cutting-out (p<0.05). Complications occurred in 26 cases (31.2%), however, there was only one case of cutting-out in reverse obliquity fracture accompanying subtrochanteric component. CONCLUSION: Complications for the treatment of peritrochanteric fracture using a gamma nail were not insignificant. To prevent cutting out of lag screw, care must be taken to keep the TAD below 25 mm.

Treatment of Intertrochanteric Fracture with Dynamic Hip Screw and Gamma Nail: A Retrospective Matched Pair Study / 대한정형외과학회잡지

PURPOSE: To compare the clinical and radiological results obtained using dynamic hip screws and Gamma nails for the treatment of intertrochanteric fracture of the femur. MATERIALS AND METHODS: We performed a retrospective study of 45 pairs of dynamic hip screw (DHS) and Gamma nail (GN) patients which were matched for sex, fracture type, and Singh index for the treatment of intertrochanteric fracture (matched pair control study). Mean duration of follow-up was 34.5 months (range, 12-62 months). RESULTS: No significant differences were found in terms of operation time, amount of transfusion, neck-shaft angle, sliding of the lag screw, union time, and mechanical complications between the two groups in the cases of stable fractures. For unstable fractures, the operation time of the DHS group was 144.7+/-40.7 minutes and that of GN group was 92.0+/-50.7 minutes (p<0.05) respectively. Mean blood transfusion units of the DHS group were 1.6 pints and of the GN group were 1.1 pints (p<0.05). No statistical differences were found between the two groups in terms of the mean duration of union, the sliding of lag screw or change of neck shaft angle in unstable fractures. Moreover there was no statistical difference between the two groups in terms of mechanical failure according to the Singh index and type of fracture. CONCLUSION: No significant differences were found between the two devices in the treatment of stable fractures. In unstable intertrochanteric fractures, Gamma nail was more useful device but only for in terms of reducing the operative time and blood loss and not in relation to union, fixibility and sliding.

Pseudoaneurysm of the Superficial Femoral Artery Following Gamma nail Fixation for Trochanteric Fracture: A Case Report / 대한정형외과학회잡지

Pseudoaneurysm of the femoral artery complicating internal fixation of the trochanteric fracture of the femur results mainly from a penetrating injury by the drill bit or screw and involves particularly the profunda femoris artery. Recently, we experienced a case of pseudoaneurysm of the superficial femoral artery following insertion of the Gamma nail for trochanteric fracture of the femur and scrutinized the causes of this injury. The superficial femoral artery lies in close proximity to the femur by adduction of the involved limb against the perineal post on the fracture table during Gamma nailing.

The Asian-Pacfic Gamma Nail for Intertrochanteric Fracture of the Femur / 대한정형외과학회잡지

PURPOSE: To evaluate the treatment results of geriatric intertrochanteric fractures by using Asian-Pacific Gamma nails. MATERIALS AND METHODS: From June 1994 to June 1997, 58 cases of the intertrochanteric fractures were treated with Asian-Pacific Gamma nail, particularly compression hip screw fixation complications such as communited fracture involving lesser trochanter, transverse or reverse oblique intertrochanteric fracture. We evaluated the bone union time, neck-shaft angle, lag screw sliding by follow up radiographs, and studied complications and intraoperative cautions. RESULTS: The average age was 74.4 years old, the mean duration of follow-up was 17 months, the mean duration of bone union was 14.2 weeks, the average neck-shaft angle was postop. 133+/-2.78 degree and last follow-up was 129.5+/-3.37 degree, and the average lag screw sliding was 4.7+/-3.16 mm. Intraoperative complications were difficulty in distal drilling (posterior drilling) in 4 cases, fracture displacement by nail insertion in 3 cases, and postoperative complications were coxa vara in 13 cases, superior cutting out of lag screw with nonunion in 1 case and superficial infection in 1 case. The entry portal must be formed by awling. The fracture displacement when inserting nail could be prevented by proper reaming after inserting the C-shaped guide pin, and posterior drilling could be avoided by confirming the locking between target device and nail. CONCLUSIONS: We conclude that the Asian-Pacific Gamma nail could appropriately treat the osteoporotic, communited intertrochanteric fracture in elderly patients and we obtained satisfactory results.