Fractures sous-trochantériennes du fémur traitées par long clou Gamma3® : une étude historique en « cas/contrôle » comparative avec le long clou trochantérique Gamma

Abstract

BackgroundGamma nail® was developed for the treatment of subtrochanteric hip fractures. Despite its advantages over extramedullary devices, gamma nail® has been historically related to significant complications (implant breakage, femoral fractures at the tip of the nail). There is limited data to determine if the rate of these complications was minimized by using a new design of the gamma nail®. Therefore we performed a case control study between the long gamma3® nail (LG3N) and the long trochanteric gamma nail® (LTGN) to assess if: 1) the complication rate in the treatment of subtrochanteric fractures using the LG3N was lower than the one using the LTGN? 2) the reoperation rate was lower after using the LG3N? HypothesisThe complication rate after fixation of subtrochanteric fracture of the femur is lower with LG3N than with the LTGN. Patients and methodsThis study prospectively recorded the intra- and postoperative complications of 75patients with subtrochanteric fractures treated with the LG3N and compared them with those of a historical cohort of 83patients treated with the LTGN. The two groups were matched regarding age, gender and fracture type. Patients with open, pathological, or impending fractures were excluded. ResultsIntraoperative complications in the LG3N group were lower (4cases, 5.3%) compared with those in the LTGN group (9cases, 10.8%; P=0.04). The major intraoperative complication encountered with the use of LTGN was fracture of the femur in 3cases. We encountered in total 9postoperative complications in LG3N (12%) and 20 in group LTGN (24%). The most frequent complication in both groups was the cut out of the lag screw (3cases in LG3N and 7cases in LTGN group). The overall reoperation rate was higher in LTGN group (20.4% vs 10.6%; P=0.03). ConclusionAs a result of the improvement of its mechanical characteristics, LG3N has proved a safe and efficient implant for the treatment of subtochanteric fractures. The new design seems superior to previous generation, giving promising outcomes, reduced mechanical complication rates, and reduced reoperation rate. Level of evidenceLevel III – case controlled study.