ABSTRACT
Two years after the first large series on the Gamma nail, the authors analyze 119 surgical procedures for proximal femur fractures performed using the 11 mm Gamma nail. The study was performed by 24 surgeons (from six orthopedics departments) at different levels of learning, as in the previous study. The small-sized nail allows an easier surgical procedure and a manual introduction of the nail even in small femurs, as suggested by the previous experience. A careful operative technique and a 2 mm overreaming, which was almost always adopted, explains the decrease in interoperative and postoperative complications (evaluated in 88 cases), compared to the last case report published in 1991. No interoperative shaft fractures occurred in 119 nailings.
Subject(s)
Bone Nails/adverse effects , Femoral Neck Fractures/surgery , Fracture Fixation, Internal/instrumentation , Intraoperative Complications/epidemiology , Postoperative Complications/epidemiology , Adult , Aged , Aged, 80 and over , Evaluation Studies as Topic , Female , Femoral Neck Fractures/diagnostic imaging , Femoral Neck Fractures/etiology , Follow-Up Studies , Fracture Fixation, Internal/methods , Humans , Incidence , Male , Middle Aged , Prognosis , Radiography , Surveys and QuestionnairesABSTRACT
A total of 1147 pertrochanteric and subtrochanteric fractures, 10 delays in consolidation and non-union, 24 pathologic fractures and osteolysis with the risk of fracture, treated with a gamma nail in 17 Italian departments of traumatology, were collected. In 70% of the patients weight-bearing was allowed during the first week postsurgery; 77% of the patients followed-up recovered the same ability to walk that had preceded trauma. Complications included intraoperative (1.8%) and postoperative (1.1%) diaphyseal fractures, cephalic screw cut out (2.2%), and breakage of the nail (0.4%). There were two cases of infection (0.3%). Most of the complications were related to errors in technique. The safest procedure is constituted by the choice of a nail with a thinner caliber, 2 mm diaphyseal over-reaming, insertion of the nail without the use of a hammer, and distal locking; the cephalic screw must always be inserted in the lower portion of the femoral head.
Subject(s)
Bone Nails , Hip Fractures/surgery , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fracture Fixation, Intramedullary/instrumentation , Fracture Fixation, Intramedullary/statistics & numerical data , Fractures, Spontaneous/complications , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/surgery , Fractures, Ununited/complications , Fractures, Ununited/diagnostic imaging , Fractures, Ununited/surgery , Hip Fractures/complications , Hip Fractures/diagnostic imaging , Humans , Incidence , Intraoperative Complications/epidemiology , Italy/epidemiology , Male , Middle Aged , Postoperative Complications/epidemiology , Radiography , Time FactorsABSTRACT
Traumatic plastic deformation is a rare occurrence in childhood and is exceptional during adult age. The authors report one case of the lesion occurring in a patient aged 20 years; they emphasize the need for adequate treatment, and formulate a pathogenetic hypothesis with a biomechanical basis.
Subject(s)
Forearm Injuries/etiology , Accidents, Occupational , Adult , Anesthesia, General , Casts, Surgical , Forearm/diagnostic imaging , Forearm Injuries/diagnosis , Forearm Injuries/therapy , Humans , Male , Manipulation, Orthopedic/methods , Pronation , Radiography , SupinationABSTRACT
In a multicentric study, the data of 628 trochanteric fractures, two non-unions, and 18 pathologic or impending fractures treated by Gamma nail in 13 Italian traumatology services were collected and analyzed. In 70% of the patients weight bearing was allowed in the first postoperative week and 78% of the controlled patients returned to their pretrauma walking ability. Complications included intraoperative (1.4%) and postoperative (1.2%) shaft fractures, "cut out" of the lag screw (2.6%), and nail failure (0.5%). There were no cases of infection. An analysis of complications showed that most of them were due to technical mistakes. The safest procedure is 2 mm diaphyseal overreaming, introduction of the nail without hammering, and distal locking; the lag screw should be placed in the lower part of the head of the femur.
