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Abstract
The objective of this retrospective study was to investigate the surgical outcomes of AO/OTA 31 A1-3 trochanteric fractures treated with the new-generation Gamma3 nail with U-Blade (RC) lag screw and to analyze the risk factors related to fixation failure. A total of 318 consecutive patients who underwent cephalomedullary nailing using Gamma3 nail with U-Blade lag screw for trochanteric hip fractures between September 2015 and June 2018 were enrolled. The average age was 80 years and most patients (69%) were women. The mean follow-up was 12.2 months with a minimum of 6 months. 309 (97.2%) showed bony union with a mean time to union of 13.5 ± 8.7 weeks. Cut-out occurred in 2 patients (0.6%) and 7 patients showed excessive collapse (≥15 mm) of the proximal fragment. These 9 patients were assigned to the failure group. The presence of a basicervical fracture component and comminution of the anterior cortex on preoperative 3-D CT showed a significant association with fixation failure, including cut-out, although comminution of the anterior cortex was the only independent risk factor for fixation failure on multivariate logistic regression analysis. Gamma3 nail with U-Blade lag screw showed favorable results for trochanteric hip fractures, with low cut-out rate (0.6%). However, more caution is required in treating trochanteric fractures with a basicervical fracture component and anterior cortex comminution even with this nail.
Highlights
Such as cut-out, the design of the nails must be taken into account in addition to patient-related characteristics, the quality of reduction, and the positioning of the lag screw
We sought to evaluate the risk factors associated with fixation failures such as cut-out
These expanded indications have led to increased use of the CM nail for almost all trochanteric hip fractures, including in cases with basicervical fracture patterns[26,27,28]
Summary
Such as cut-out, the design of the nails must be taken into account in addition to patient-related characteristics, the quality of reduction, and the positioning of the lag screw. An additional U-Blade (RC) lag screw for the Gamma[3] nail was introduced to provide additional rotational stability to the proximal fragment. This nail allows replacing the standard lag screw with a U-blade lag screw set (a combination of the lag screw with a U-shaped clip increasing the diameter by 2 mm). To date, the current literature contains little information about the surgical outcomes of the use of Gamma[3] nail with U-Blade lag screw in trochanteric hip fractures. The objective of this retrospective study was to investigate the surgical outcomes of AO/OTA 31 A1-3 trochanteric hip fractures treated with Gamma[3] nail with U-Blade lag screw (Fig. 1). We sought to evaluate the risk factors associated with fixation failures such as cut-out
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