ABSTRACT
The Gamma Nail is the latest advance in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures. Its design is based on Küntscher's Y-nail and locking intramedullary (IM) nails. This paper reports the results from the first-ever series of 121 patients operated between 1988 and 1990. They were followed until bone union was achieved. The mean patient age was 75 years. Most patients were in poor general health and had unstable fractures. Anatomical preoperative reduction was achieved in 72% of cases. Fixation was good in 66% of cases and acceptable in 27% of cases. Intra-operative complications consisted of nine fractures without consequences. Of the treated patients, 83.4% resumed weight-bearing during the first week. There was one case of deep infection that resolved with treatment. The mortality rate was 12.3% at three months. We noted 7 alunions in varus, 3 in valgus, 2 in external rotation and 1 in internal rotation. There were no cases of non-union. In six cases, the screw had cut out of the femoral head. The drawbacks associated with surgical treatment methods for trochanteric fractures also apply to the Gamma nail. Nevertheless, one of its primary advantages is the possibility of using a closed procedure. When compared to Ender nailing, knee pain is absent and weight-bearing can be achieved in all patients, no matter the fracture type.
Subject(s)
Bone Nails , Fracture Fixation, Intramedullary/methods , Fractures, Closed/surgery , Hip Fractures/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prosthesis Design , Young AdultABSTRACT
Ninety-seven patients type II were in this study. There were 35 male and 53 female patient, whose average age at revision was 74,5 year old. In this group the average time to fracture after arthroplasty was 6,2 (1-20) years.The fracture was spiral in most cases (82%), but some there were transverse (18%). Loosening of the prosthesis often occured with the transverse fracture (p=0,001).Loosening occured in 30% cases before the femoral fracture : it was rarely a major, but its duration was unknown.Three different methods of treatment were used in this study: - conservative treatment was used rarely, where there was a surgical risk in incomplete or undisplaced fracture. Treatment with traction involved a prolonged stay in hospital (two months average). - internal fixation without removal of the prosthesis was used in 44% cases. Fixation with plates in 93%. Other devices were screw and cerclage wire fixation. - 47,5% cases were revised with a long stem cemented prosthesis. The most difficult was type II fracture associated with femoral loosening. The location of type II fracture may compromise the stability of prosthesis. Although there was 41% of cases whose prosthesis was not loose before fracture. In these cases, type II fracture has not compromised the stability of prosthesis: the spiral line could shape peri prosthetic mantle of cement.Healing of the fracture was obtained in most cases (97%). Thus, protetic loosening created by type II fracture has not prevented consolidation: these two events are statistically independant.The present retrospective study supports the employement of different treatment. Based on these findings, the following management of type II fracture could be recommended: - undisplaced or incomplete fracture in high risk patients, should be treated conservatively. If loosening of the prosthesis develops, revision of the arthroplasty can be done after fracture healing. - internal fixation without revision of the prosthesis should be employed if the prosthetic stem stability is not compromised. - revision of the arthroplasty should be done if loosening of the prosthesis developped before or during the type II fracture occured. Then, a long stem should be employed.
ABSTRACT
The Gamma Nail, developed at the Centre for traumatology and orthopaedics of Strasbourg, is the latest advance in the treatment of trochanteric fractures, based on the intra-medullary principle and on the closed procedure. It was inspired both by the Y nail of Küntscher and by the interloking nail. This is the study of the results of a first series of 121 cases treated between 1988 and 1990 and followed until consolidation. The mean age was 75 years, mostly patients in poor general condition, unstable fracture types were predominant. The preoperative reduction was anatomic in 72 per cent and the quality of osteosynthesis was good in 66 per cent, acceptable in 27 per cent; 83.4 per cent of the patients resumed full weight bearing during the first week. Only one case of deep infection occurred, treated by Gentamicyn beeds without removal of the nail. The mortality rate was 12.3 per cent at three months. We note 7 malunions in varus > 10 degrees, 3 in valgus > 10 degrees, 2 in external rotation > 10 degrees and 1 internal rotation > 10 degrees. In six cases, there was a cut out of the femoral head by the screw (in two cases the screws were too short, in four cases they were in a bad position). The same criticism against all surgical methods of treatment of trochanteric fractures can be done against the Gamma Nail. Nevertheless, it keeps the advantages of a closed procedure and, in comparison to the Ender nail, the absence of knee pain and the systematic weight bearing whatever the fracture type.
