Gamma Nail Research Articles

Poor usability of computer-assisted navigation for hip fracture surgery

IntroductionThe STRYKER ADAPT computer-assisted navigation system provides intraoperative feedback to the surgeon regarding implant placement of the Gamma3 nail. The usability of the ADAPT system has not been evaluated. The aim of the study was to investigate the perceived usability of the ADAPT system.Materials and methodsThis was a descriptive study with prospectively collected data. ADAPT was introduced at Aarhus University Hospital in February 2021. Prior to introduction, surgeons at the department attended a general introduction to the system. ADAPT was introduced to the surgical nurses and was on display at the surgical ward at more than one occasion, where personal introduction to the system was possible. After introduction, it was mandatory to use ADAPT when using the Gamma3 nail to treat intertrochanteric femur fractures. After each procedure, primary and an eventual supervisor answered a questionnaire, which encompassed the System Usability Scale (SUS) questionnaire. The SUS is a ten-item questionnaire regarding the perceived usability of a system. SUS scores were translated to adjectives, describing user experience on a 7-point adjective scale (worst imaginable, awful, poor, ok, good, excellent, best imaginable). User acceptability, defined as “not acceptable”, “marginal” or “acceptable”, was also used to interpret the SUS scores.ResultsADAPT was used in 50 procedures by 29 different surgeons, with varying skill-level. Median SUS-score after first-time use of ADAPT for all 29 surgeons was 43 (range: 5–60), which translated to “poor” or “not acceptable”. For surgeons who performed ≥ 3 ADAPT-assisted procedures, there were no statistically significant difference in their first to latest SUS-score (median difference: 4.3, p = 0.5). In free text comments ADAPT was positively described as helpful in placement of K-wire and providing educational opportunities for inexperienced surgeons and negatively as inconsistent, slow, time consuming, and causing excessive fluoroscopy.ConclusionsUsability and acceptability of ADAPT was rated as “poor” or “not acceptable” by the majority of operating surgeons. ADAPT has not been used at our institution based on these findings. The System Usability Scale may be used in further research exploring usability and acceptability of novel computer-assisted navigation systems for orthopaedic surgery.

Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis.

To establish the background rate of breakage of cephalomedullary nails. MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew. The author, year of publication, dates of implant insertion, study design, method of detection of breakages, implant used, number of implant breakages, number of implants inserted, breakage rate, and follow-up were extracted. Meta-analysis of included studies used descriptive nonparametric statistics and a noncomparative proportion for the pooled result. Differences in results between study design types were compared using the mean breakage rate per study design. Cephalomedullary nail breakage is a rare complication with a median reported rate of 0.6% and a pooled result rate of 0.4%. Ninety-five percent of studies had a breakage rate of 1.3% or less, which sets a benchmark from the reported literature for future studies. There is wide variability in rates of breakage reported between different types of study designs with single-center review studies reporting breakage rates nearly 4-fold greater than large-scale administrative database reviews. The rate of implant breakage should not be used in isolation to judge an implant's performance. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Dual-screw versus single-screw cephalomedullary nails for intertrochanteric femoral fractures: a systematic review and meta-analysis

BackgroundInternal fixation with cephalomedullary nails has been widely used in the treatment of intertrochanteric femoral fractures (IFF). Yet, the difference in efficacy and safety between the commonly used integrated dual-screw cephalomedullary nail (InterTAN) and single-screw cephalomedullary nail remains inconclusive. Thus we performed the present systematic review and meta-analysis.MethodsRandomized controlled trials (RCTs) or observational studies comparing InterTAN with proximal femoral nail anti-rotation (PFNA), the Asian PFNA (PFNA-II), or the Gamma3 nail in treating IFF were searched on PubMed, EMBASE, Web of Science and Cochrane Library from inception to April 30, 2023. The differences in perioperative parameters and clinical and radiological outcomes were evaluated by mean difference (MD) with 95% confidence interval (95%CI). The risks of various complications and mortality were assessed by risk ratio (RR) with 95%CI.ResultsTwenty-three studies comprising 3566 patients were included. Compared with single-screw cephalomedullary nails (PFNA/PFNA-II, Gamma3), InterTAN conferred significantly reduced risk of implant failures (RR = 0.37, 95%CI 0.26 to 0.51, P < 0.001), hip and thigh pain (RR = 0.70, 95%CI 0.55 to 0.90, P = 0.006) and all-cause revision/reoperation (RR = 0.38, 95%CI 0.26 to 0.57, P < 0.001). Moreover, patients treated with InterTAN had significantly higher 1-year Harris Hip Score (MD = 0.82, 95%CI 0.20–1.44, P = 0.010) and shorter time to union/healing (MD = − 0.66 days, 95%CI − 1.16 to − 0.16, P = 0.009). Femoral neck shortening, time to full bearing, and incidences of non-union, infection, deep venous thrombosis, and mortality were comparable between both groups.ConclusionsThe integrated dual-screw InterTAN construct has superior performance in reducing risks of complications and improving clinical and functional outcomes in the treatment of IFF. More well-designed, high-quality RCTs are warranted to confirm these findings.

Correlation between Inflammatory Systemic Biomarkers and Surgical Trauma in Elderly Patients with Hip Fractures.

The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) and the level of aggression sustained by elderly patients during these surgical procedures. A total of 129 patients aged over 70 and diagnosed with acute hip fractures who underwent surgical treatment between November 2021 and February 2023 were included in our observational retrospective cohort study. Two groups were formed depending on the anatomic location of the fracture for statistical comparison: group 1 with extracapsular fractures, who received a closed reduction internal fixation (CRIF) with a gamma nail (GN) as treatment, and group 2 with intracapsular fractures, who received a bipolar hemiarthroplasty (BHA) as treatment. The length of hospital stay (LHS), duration of surgery, preoperative days, pre- and postoperative red blood count (RBC) and hemoglobin (HGB) levels and postoperative NLR, PLR and SII were significantly different between the two groups (p < 0.05). Furthermore, the multivariate analysis indicated that the postoperative NLR (p = 0.029), PLR (p = 0.009), SII (p = 0.001) and duration of surgery (p < 0.0001) were independently related to the invasiveness of the procedures. The ROC curve analysis demonstrated that a postoperative SII > 1564.74 is a more reliable predictor of surgical trauma in terms of specificity (58.1%) and sensitivity (56.7%). Postoperative SII as a biomarker appears to be closely correlated with surgical trauma sustained by an older population with hip fractures.

Surgical treatment of elderly and senile patients with transtrochanteric fractures of the femur

+ The aim of the work was to analyze the functional results of surgical treatment in elderly and senile patients with transcavitary fractures depending on the method of osteosynthesis. Materials and methods. 134 elderly and senile patients with transtrochanteric fractures of the femur type 31A1.1-A1.3 according to AO/ASIF were examined (average age - 72.4±9.3 years). The patient underwent osteosynthesis with a DHS fixator, a PFNA rod and a Gamma nail according to indications. The functional result of the treatment was determined by radiographic signs of fusion, the Harris scale, and complications detected during the period of 1, 3, 6, and 12 months of examination. Results and their discussion. The functional result according to the Harris scale dramatically prevailed in the first six months after surgical treatment with intramedullary osteosynthesis. For the DHS fixator, the indicator improved from 29.8 points in the first month to 57.7 at the sixth month, for the PFNA rod - from 50.7 points to 76.9, and for the Gamma nail from 50.1 to 76.7, respectively. Consolidation of a transtrochanteric fracture in treated elderly and senile patients was observed in 83.33 % of cases after extramedullary osteosynthesis, and in 90.22 % of cases after intramedullary osteosynthesis. Complications of extramedullary osteosynthesis included instability of the fixator with migration and fracture of the fixator, during intramedullary osteosynthesis – migration of the cervical blade "cut-out" and fracture of the rod. Conclusions. The functional result in elderly and senile patients with transtrochanteric fractures after intramedullary osteosynthesis has advantages over extramedullary osteosynthesis. The results of the calculation of the Harris scale indicators, among which the evaluation of the restoration of gait, movements and resistance of the injured limb were decisive, are significantly higher in osteosynthesis with a Gamma nail and a PFNA rod in comparison with a DHS fixator. Complications that occurred in the three groups of the study coincide with the average international indicators and are not significantly low with intramedullary osteosynthesis. Improvement of surgical treatment methods is urgent and requires the search for complex treatment approaches in elderly and senile patients with transtrochanteric fractures

The effects of three different low-molecular-weight heparins on blood loss after intramedullary nailing of trochanteric fractures.

The purpose of this study was to compare the effects of reviparin, dalteparin and enoxaparin on intraoperative blood loss in patients with trochanteric fracture treated with intramedullary nailing. This retrospective multicenter study included 100 patients with trochanteric fracture who were divided into three groups according to the low-molecular-weight heparin administered. In all cases, a short third generation Gamma nail was used for osteosynthesis. Complete blood count and number of red blood cell transfusions (RBC) were evaluated. The mean value of postoperative haemoglobin level was lower in the enoxaparin group compared to the reviparin group, with significant difference (p = 0.001; 95% CI 4.1-18.87). Patients in the dalteparin group received more RBC transfusions compared to the reviparin and enoxaparin group (p = 0.048). The use of enoxaparin and dalteparin in hip fracture patients can result in lower postoperative haemoglobin levels and more RBC transfusions compared to reviparin.

Fractures of the Proximal End of the Femur: Exploration of Treatments and Assessment of Outcomes

ABSTRACT Fractures of the proximal extremity of the femur are some of the most common injuries treated by orthopedic surgeons, often associated with life-threatening polytrauma. Trochanteric fractures have an increased incidence, which is becoming more common due to the aging population. Femoral neck fractures are a particular type of intracapsular hip fracture, and the location of the junction makes the femoral neck prone to fracture. Fractures of the femoral shaft are found in approximately 6-9% of cases of femoral neck fractures. The management of these fractures is interdisciplinary, but in most cases, it requires surgical treatment to allow rapid elevation and recovery of autonomy. The present study is retrospective in which 140 cases of fracture of the upper femur extremity collected at the trauma department of Naousa and Kilkis Hospital over 4 years from December 2018 to December 2022 were analyzed, processed, and reviewed with a minimum follow-up of 6 months. The purpose of this article is to analyze the frequency of various types of fractures of the proximal extremity of the femur and to identify the etiological factors that contribute to these injuries, thus providing a comprehensive understanding of these traumatic events to treat them. The study showed that there is a preponderance of trochanteric fractures, with an increased frequency in the 75-89 age group and a predominance of femoral neck fractures in women, mainly caused by falls. External surgical approaches, standard gamma nail, and bipolar treatment had "excellent/good" functional results reflecting the success of the surgical interventions. The high frequency of anatomical reductions underlines the attention paid to the quality of the procedures.

IMPROVED MECHANICAL ANCHORAGE OF GAMMA NAIL LAG SCREW IN OSTEOPOROTIC BONE: A BIOMECHANICAL STUDY

A number of techniques have been developed to improve the immediate mechanical anchorage of implants for enhancing implant longevity. This issue becomes even more relevant in patients with osteoporosis who have fragile bone. We have previously shown that a dynamic hip screw (DHS) can be augmented with a calcium sulphate/hydroxyapatite (CaS/HA) based injectable biomaterial to increase the immediate mechanical anchorage of the DHS system to saw bones with a 400% increase in peak extraction force compared to un-augmented DHS. The results were also at par with bone cement (PMMA). The aim of this study was to investigate the effect of CaS/HA augmentation on the integration of a different fracture fixation device (gamma nail lag-screw) with osteoporotic saw bones.Osteoporotic saw bones (bone volume fraction = 15%) were instrumented with a gamma nail without augmentation (n=8) or augmented (n=8) with a CaS/HA biomaterial (Cerament BVF, Bonesupport AB, Sweden) using a newly developed augmentation method described earlier. The lag-screws from both groups were then pulled out at a displacement rate of 0.5 mm/s until failure. Peak extraction force was recorded for each specimen along with photographs of the screws post-extraction. A non-parametric t-test was used to compare the two groups.CaS/HA augmentation of the lag-screw led to a 650% increase in the peak extraction force compared with the controls (p&lt;0.01). Photographs of the augmented samples shows failure of the saw-bones further away from the implant-bone interface indicating a protective effect of the CaS/HA material.We present a novel method to enhance the immediate mechanical anchorage of a lag-screw to osteoporotic bone and it is also envisaged that CaS/HA augmentation combined with systemic bisphosphonate treatment can lead to new bone formation and aid in the reduction of implant failures and re-operations.

Comparison of treatment of unstable intertrochanteric fractures by intramedullary and extramedullary implants

Background To achieve union and restore the normal biomechanics of the hip region after unstable trochanteric fractures, surgical intervention is necessary. There are two options for internal fixation: extramedullary and intramedullary. Dynamic hip screw (DHS) as extramedullary fixation was and is still widely used to surgically treat intertrochanteric fractures. However, it sometimes fails to give good results. Intramedullary fixation methods include gamma nail placement, which is considered by some surgeons to be a better choice as it can avoid complications occurring with extramedullary fixation. Our study aimed to conclude which is better to be used to manage unstable intertrochanteric fractures by either DHS or gamma nail regarding the operation requirements (hospital stay, need for blood transfusion, wound complications, and soft tissue damage) and later on evaluate which is better regarding the fracture healing radiologically and functionally. Patients and methods This is a retrospective study of 52 patients with recent unstable intertrochanteric fractures between January 2020 and December 2020. A total of 40 patients continued the study till the last follow-up, where 20 of them were fixed by intramedullary gamma nails as a group I and the other 20 patients were fixed by extramedullary DHS as a group II. The mean age for the group I was 50.05 (20–83) years and the mean age for group II was 60.5 (22–91) years. A total of 14 patients from group I were males and 12 from group II were males. All fractures were classified according to Evan’s classification to be unstable (Evan’s types III, IV, and V). Results Overall, 19 (95%) patients of group I achieved full union and one patient had nonunion with nail breakage. No patients in group I had malunion. A total of 17 (85%) patients of group II achieved good union with one patient having nonunion with implant failure. Moreover, two (10%) patients of group II had femoral shaft medialization and varus malunion. Conclusion This study supported the previous series in the literature, which proved that unstable intertrochanteric fractures can be fixed by intramedullary gamma nails or extramedullary DHS but intramedullary fixation gives better results than extramedullary fixation.

Evaluation of the results of intertrochanteric femur fractures fixation by dynamic hip screw versus gamma nail

Background: Femoral intertrochanteric fractures account for approximately half the hip fractures in elderly patients. The aim of this study is to evaluate the results of the treatment of intertrochanteric fractures in adults using Dynamic Hip Screw (DHS) and Gamma nail (GN) and evaluate radiologically the effect of these implants on normal proximal femoral morphology.Methods: This prospective randomized study was carried out on 40 patients ranged from 18 to70 years old (20 patients were managed by Dynamic Hip Screw (DHS) and 20 patients were managed by GN). Patients were subjected to: history taking, physical examination, mechanism of trauma, the harris hip score (HHS), radiographic evaluation.Results: There was significant difference regarding operative time, number of gauzes soaked with blood, number of C-arm shots and follow up time and insignificant difference Regarding gender, age or occupation, comorbid diseases and mechanism of injury or side of lesion, HHS score, postoperative complications, and postoperative changes of proximal femur, Conclusions: In femur fractures fixation, DHS and GN are useful in the treatment of trochanteric femoral fractures, although the results were slightly in favor of DHS fixation (in stable fractures), GN has shorter operative duration, less blood loss, earlier weight bearing despite of higher number of C-arm shots needed.

Comparative study of dynamic hip screw and gamma nail in the treatment of stable intertrochanteric fracture

Comparative study of dynamic hip screw and gamma nail in the treatment of stable intertrochanteric fracture

Reduced cutout for reverse oblique intertrochanteric hip fractures treated with trochanteric fixation advanced (TFN-A) nail compared to the short gamma-3 nail.

Reverse oblique fractures (AO/OTA 31-A3) account for 5-23% of all intertrochanteric fractures and are challenging to manage. The Gamma 3-Proximal Femoral Nail (GPFN) and the Trochanteric Fixation Nail Advanced (TFNA) are two common cephalomedullary systems used to treat this fracture. No study has reported on outcomes with the TFN-A for reverse oblique fractures. This study aimed to compare outcomes and complication rates in patients with reverse oblique fractures, treated with either TFNA or GPFN. A total of 203 patients with reverse oblique fractures (137 in the GPFN group and 66 in the TFNA group), were treated in our institution between June 2010 and May 2019. Data was collected on postoperative radiological variables including screw or blade location, and tip-apex distance (TAD). Data were also collected for non-orthopaedic complication rates and orthopaedic complications. A sub-group analysis was additionally performed for different nail lengths. We found no significant difference in the overall rate of complications and revisions between the two groups. Patients treated with the 235mm TFN-A nail sustained lower rates of cutout, compared to 180mm GPFN (GPFN: 6% TFN-A: 0%, p=0.043). The frequency of revision surgeries and malunions/non-unions did not differ significantly between the two groups and additionally showed no difference in the subgroup analysis. The 235mm TFN-A was associated with lower rates of cut-out compared to the short GPFN for reverse oblique intertrochanteric fractures. Future well-designed prospective studies are warranted to investigate the role of the TFN-A in improving outcomes for such fractures.

Complications Following Short Femoral Nail Fixation for Intertrochanteric Hip Fractures: A Retrospective Study.

The incidence of proximal femur fractures is increasing due to aging of the population. Intramedullary nails are the mainstay of treatment for intertrochanteric hip fractures mainly due to their better biomechanical properties compared to dynamic hip screw devices, shorter operative time, and less blood loss during surgery. However intramedullary nail fixation is not devoid of complications. The purpose of this study is to look at complications related to intramedullary nailing for intertrochanteric hip fractures in a major trauma center. A retrospective study was conducted including all patients having suffered an intertrochanteric femur fracture and treated with intramedullary nails from October 1, 2020, to October 1, 2022, in the Orthopaedic Surgery Clinic. The intramedullary hip systems used were the Stryker Gamma3 Nail and the VITUS PF Nail. All complications following the postoperative period were recorded in detail. Overall, 240 patients with a mean age of 82.3 years treated with hip intramedullary devices were identified. Superior cutout of the lag screw in two patients (females 90 and 87 years old) was identified 8 and 10 weeks following initial surgery. Avascular necrosis (AVN) of the femoral head was identified in one patient (male 81 years old) which occurred 12 weeks postoperatively. All three cases were revised by replacing the nail with cemented hemiarthroplasty. Periprosthetic fractures occurred in an 88-year-old male and a 73-year-old female following an injury distal to the stem and were managed by replacing the nail with a long stem device (Long Gamma3). One case of metalwork fracture was also recorded. There are many advantages in managing intertrochanteric hip fractures with intramedullary hip devices such as shorter theater time, less blood loss, and improved biomechanical properties. However, complications such as cutout of the lag screw, AVN, and periprosthetic fracture are serious and require complex revision surgery.

Retracted: X‐Ray Film under Artificial Intelligence Algorithm in the Evaluation for Nursing Effect of Gamma Nail Internal Fixation in Elderly Patients with Intertrochanteric Fracture of Femur

Retracted: X‐Ray Film under Artificial Intelligence Algorithm in the Evaluation for Nursing Effect of Gamma Nail Internal Fixation in Elderly Patients with Intertrochanteric Fracture of Femur

Clinical outcomes of the intramedullary femoral nailing system in the treatment of femoral fractures

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Femoral fractures are a common type of fracture brought on by large force impaction. This study's objective was to clinically assess the results of using an intramedullary femoral nailing system to treat femoral fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 32 patients with femoral fractures are included in this retrospective clinical trial. They are all treated with an intramedullary femoral nailing system made by Kaulmed private limited in Sonipat, Haryana, India. This system includes KN-1 advance nails (PFNA), KN-6 femur nails (retrograde Nails), KN-3 nails type II (gamma nails), KN-2F femur nails (expert femoral nails), and KN-5F universal intramedullary cannulated femoral nails. There were 32 patients, with 15 from one hospital and 17 from the other. The first hospital group consisted of 8 men and 7 women, with an average age of 32 years and the second hospital group consisted of 9 male and 8 female with mean age of 40.5 years. The fractures were categorized based on AO classification and pre-operative fitness was assessed using American society of anaesthesiologist (ASA Grade). The clinical effectiveness was evaluated using the VAS score and anatomical results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Surgery was performed on 32 patients with at-least three post-operative follow-up visits in 180 days. No patient in any group complained after the final follow up about complications or hardware problems, and every patient's bone union was achieved successfully. Radiological outcomes also showed proper union at 6 months. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In femoral fractures, the intramedullary femoral nail provides better results with a high rate of union and postoperative composure.&lt;/p&gt;

A retrospective study on internal fixation of femoral neck fractures with Hansson Pins® in Switzerland

Background: Hansson Pins® (The Swemac Group, Linköping, Sweden) are devices for the internal fixation of femoral neck fractures that are widely used in Scandinavia. The authors hypothesized that the pins could be used with satisfactory results outside of Scandinavia, that they were a valid alternative to cancellous screws and the dynamic hip screw, and that they also could be used in elderly patients. Methods: Sixty-five consecutive patients with femoral neck fractures who received internal fixation with Hansson Pins between January 2007 and December 2016 at the Oberengadin Hospital in Switzerland were included in this retrospective study. The hospital’s electronic database was searched for information, and questionnaires were sent to the patients. Results: After internal fixation with Hansson Pins, 22% of the patients needed a hip prosthesis. For patients 70 yr and older, this rate was 33%. For 60% of the patients who needed a hip prosthesis, the reason for arthroplasty was nonunion. For 20%, the reason was avascular necrosis of the femoral head, and for another 20% of the patients symptomatic coxarthrosis was the cause. Conclusions: The rate of salvage arthroplasties in this study was similar to the rates in the literature of Hansson Pins (mostly from studies performed in Scandinavia), cancellous screws and dynamic hip screws. The findings suggested that Hansson pins could be used with good results outside of Scandinavia and that they were a reasonable alternative to cancellous screws and the dynamic hip screw. The pins also could be used with satisfactory outcomes in elderly patients, but the rate of salvage arthroplasties would be higher. Level of Evidence: Level IV.

Are The Lateral Wall Reduction And Ideal Tip-Apex Distance Important In Reverse Oblique And Transverse Intertrochanteric Femoral Fractures (31-A3) Treated With Gamma Nail?

Purpose: Reverse oblique and transverse intertrochanteric femoral fractures (31A3 AO/OTA classification) have their own mechanical and anatomical properties. The aim of our study is to verify whether the reduction of the lateral femoral wall and ideal tip-apex distance are important predictive factors in the future of these fractures treated by gamma nails in terms of healing and complication rates. Methods: The radiological and clinical outcomes of 35 fractures of this type treated by short and long gamma nail from June 2014 to April 2021 were retrospectively reviewed. The elements considered were the quality of the lateral femoral wall reduction, the tip-apex distance (TAD), the lag screw position and overall quality reduction using the Baumgaertner criteria. Union, nonunion, cutout, screw sliding, nail or screw breakage were also radiographically evaluated during follow-up. Results: The union rate was 97%. A significant association was not observed between the state of reduction of the lateral wall and the three types of complications considered (cutout: p=0.31; sliding screw: p=1.00; varus displacement: p=0.30), and the linear regression model obtained indicates that in subjects with a non-reduction of the lateral wall, the consolidation time is increased on average by approximately 3 months (β= 2.99; 95%CI: 1.79-4.20, p&lt;0.001). No significant association was found between TAD and complications (cut-out: p=1.00; sliding screw: p=1.00; varus displacement: p=0.13). Conclusion: Anatomic reduction of the lateral wall and an ideal TAD ≤ 25mm might not be as significant for 31A3 fractures treated with gamma nails. Acceptable reduction of the lateral wall and stable internal fixation are sufficient elements to achieve fracture healing and functional recovery.

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

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. A retrospective single-centre study was performed on patients ≥ 60years admitted for a trochanteric fracture between September 2016 and January 2020. Surgical revisions and lag screw displacement were evaluated at6 weeks and 1-year follow-up, respectively. 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 2.5mm, which was similar for static and dynamic locking (2.3mm versus 2.7mm; p 0.785). 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.

Subtrochanteric femoral fractures and intramedullary nailing complications: a comparison of two implants

IntroductionIntramedullary (IM) nails are considered the ‘gold’ standard treatment for subtrochanteric femoral fractures. The incidence and risk factors for re-operation in subtrochanteric fractures remain unclear. Furthermore, no studies have compared the outcomes of different nailing systems used to treat subtrochanteric fractures in the same study population.Aims/objectivesOur study aimed to (i) investigate the cumulative incidence and factors associated with an increased risk of re-operation in subtrochanteric fractures treated with a long intramedullary (IM) nail, (ii) compare the outcomes of subtrochanteric fractures treated with long Affixus and Gamma nails, and (iii) establish whether the addition of a proximal anti-rotation screw in the Affixus nail confers any clinical benefit.MethodsA retrospective review of all adult patients admitted to a level 1 trauma centre with a subtrochanteric femur fracture treated with a long cephalomedullary IM nail over an 8-year period was conducted. Exclusion criteria were primary surgery performed at another institution, prophylactic nailing because of tumours, incomplete fractures, and patients who were lost to follow-up or died before fracture healing. Data variables were assessed for normality prior to determining the use of either parametric or non-parametric tests. Logistic regression analysis was performed to identify potential factors associated with re-operation. For the comparison between the two nail types, patients were matched into two groups of 119 each by age (10-year intervals), gender and mechanism of injury (low energy, high energy and pathological fractures). A p-value < 0.05 was considered significant. The Kaplan–Meier nail survival curve was used to demonstrate the survival of each nail. Data were analysed using the statistical package R (R version 3.6.0).ResultsA total of 309 subtrochanteric fractures were treated with a distally locked long IM nail (re-operation rate: 22.33%) over an 8-year period. Logistic regression identified six factors associated with an increased risk of re-operation, including age < 75 years old, use of a long Gamma nail, pre-injury coxa-vara femoral neck shaft angles, an immediate post-operative reduction angle of > 10° varus, deep wound infection and non-union.Following matching, we compared the two long cephalomedullary nailing systems used (Gamma versus Affixus nail). The only differences identified from the unadjusted analysis were a higher overall incidence of nail failure in Gamma nails due to any cause, re-operation, and impingement of the nail tip distally against the anterior femoral cortex. When we corrected for covariates, no significant differences remained evident between the two nails. From the Kaplan–Meier nail survival curves, however, the Affixus nail demonstrated better survivorship up to 5 years post-implantation in terms of nail failure and re-operation for all causes. Finally, the addition of a proximal anti-rotation screw in the Affixus nail did not seem to confer any benefit.ConclusionWe reported a 22.3% re-operation rate in our cohort of subtrochanteric fractures treated with a long IM nail. We have identified six risk factors associated with re-operation: age < 75 years old, pre-injury femoral neck shaft angle, choice of nail, varus reduction angle, fracture-related infection and non-union. The addition of a proximal anti-rotation screw in the Affixus nail did not confer any benefit.

Ipsilateral Femoral Neck and Trochanter Fracture: A Case Report and Literature Review

Simultaneous ipsilateral femoral neck and trochanteric fracture is a rare injury. it occurs most commonly in elderly patients with low energy trauma. Its management present a significant challenge to the orthopaedic surgeons. We report the case of 77 years old male, who sustained simultaneous transcervical femoral neck and intertrochanteric fractures caused by an olive tree fall. The patient was treated with a standard gamma nail, with a satisfactory functional result at 3 months follow-up.