Locking in trochanteric fractures: a comparison of static versus dynamic locking using the Gamma3 nail.

PURPOSE: The Gamma3 nail (Stryker®) is an intramedullary device consisting of a proximal lag screw and distal interlocking screw. It is still unknown whether the screw locking mode could influence clinical outcomes. The aim of this study is to compare static and dynamic screw locking regarding their influence on surgical revisions and lag screw displacement. METHODS: A retrospective single-centre study was performed on patients ≥ 60 years admitted for a trochanteric fracture between September 2016 and January 2020. Surgical revisions and lag screw displacement were evaluated at 6 weeks and 1-year follow-up, respectively. RESULTS: A total of 142 patients were included for analysis. Surgical revisions were needed in 13 cases (9.2%). Indications included implant breakage (n = 3), lag screw cut-out (n = 3), lateral hip pain (n = 6) and non-union (n = 1). The number of surgical revisions was not different between static and dynamic locking (OR 2.55; 95%CI 0.73-8.56; p 0.142). The median lag screw displacement was 2.5 mm, which was similar for static and dynamic locking (2.3 mm versus 2.7 mm; p 0.785). CONCLUSION: The screw locking mode of the Gamma3 nail is not associated with a higher risk of surgical revisions. However, the design of the Gamma3 nail may not be suitable for static locking.

[Nitrous oxide is not widely used for children in the emergency departments in The Netherlands]. / Lachgas wordt niet algemeen toegepast bij kinderen op de SEH.

Nitrous oxide was introduced in The Netherlands as an easily accessible and effective agent for procedural sedation and analgesia (PSA) in children at the Emergency Department. It was expected that its adoption would increase due to the rapid onset of action, limited side effects and the non-invasive character. In this article, we discuss the efficacy and use of nitrous oxide in The Netherlands. Nitrous oxide is a safe and effective agent for children undergoing low-complex procedures. However, the analgesic effect is limited for complex procedures such as fracture reposition, necessitating the use of additional agents such as opioids. Against our expectations, most Dutch Emergency Departments do not use nitrous oxide. Reasons for this are the limited analgesic effects for most procedures, the availability of good alternatives and cost and sustainability considerations.