Estudio prospectivo aleatorizado sobre la influencia del bloqueo distal del clavo Gamma 3 en el tratamiento de las fracturas pertrocantéreas de fémur

Abstract

ObjectiveThe purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. Material and methodsDetails were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. ResultsThe patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p<0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p<0.05), but this significance disappears when adjusting for other patient-related characteristics. ConclusionsBased on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use.