Unstable Pertrochanteric Fractures Research Articles

Complications and technical problems with the gamma nail

A retrospective review of complications with the gamma nail has been carried out in 152 patients with stable and unstable pertrochanteric fractures. Operative complications occurred in 10 patients. Screws penetrated the femoral neck in 3, immediate varus was associated with a short screw in 2, diaphyseal fractures occurred at the site of the distal screws in 3 and comminuted femoral fractures in 2. Fifteen patients (10.5%) died in hospital. At follow up, pseudarthrosis was present in 2 cases and fractures of the femoral shaft in 4. The incidence of complications could be reduced by using of shorter nails, less valgus angulation and by not introducing distal screws unless essential.

Treatment of Unstable Peritrochanteric Fractures in Elderly Patients with a Compression Hip Screw or with the Vandeputte (VDP) Endoprosthesis: A Prospective Randomized Study

A prospective randomized study was set up, comparing a compression hip screw with the Vandeputte (VDP) endoprosthesis treatment for fresh, unstable peritrochanteric fractures, according to the Evans-Jensen and AO systems. Ninety patients, ages > or = 70 years, 47 of whom were treated with a compression hip screw and 43 with a VDP endoprosthesis, were included. All patients were being followed for 3 months. No difference between the two groups was found for operating time, wound complications, and mortality rate, but there was a higher transfusion need in VDP treatment. Severe fracture redisplacement or total collapse of the fracture occurred in 11 (26%) compression hip screw patients, two of whom had revision surgery. Only one patient needed reintervention after VDP treatment. Functional capacity of preoperative independent patients at hospital discharge did not differ for the two groups. In conclusion, the compression hip screw seemed to be an appropriate implant for most of the peritrochanteric fractures, but for very old patients with advanced osteoporosis, with a complex, unstable peritrochanteric fracture, and who are eligible for early mobilization, primary cemented endoprosthesis might be the best treatment.

大腿骨転子部骨折におけるガンマ釘の小経験

Over a three year period we treated 52 patients with stable and unstable peritrochanteric fractures. However, unstable intertrochanteric and subtrochanteric fractures are difficult to fix and can present problems in management.We describe the preliminary results of early cases treated with the Gamma-Nail. Our results indicate that the Gamma-Nail allows adequate fixation for unstable fractures, shorter operative time, less blood loss, earlier weight bearing, shorter hospital stay and overall lower morbidity.

A new device for the fixation of unstable pertrochanteric fractures of the hip.

A new type of fixation device for the treatment of pertrochanteric fractures of the hip is described. The device has an axial-compression screw to allow compression along an axis parallel to the femoral shaft. As the fracture settles postoperatively, dynamic axial compression continues. This axial-compression device was used in twenty-five patients who had an unstable intertrochanteric or proximal subtrochanteric fracture of the proximal part of the femur. The average extent of axial impaction or settling was five millimeters (standard deviation, 1.3 millimeters) at the most recent follow-up examination, and the relationship between the femoral head and shaft was altered less than with the use of a conventional compression screw-plate device. A larger proportion of the patients who had the new device were able to walk fifteen meters (fifty feet) independently by the time of discharge from the hospital, even though they left the hospital earlier. No technical failures were seen in the patients who were treated with the axial-compression screw device. We believe that the axial-compression screw-plate device is appropriate for the treatment of unstable pertrochanteric fractures of the hip.

A prospective controlled trial of valgus osteotomy in the fixation of unstable pertrochanteric fractures of the femur

A total of 62 patients with unstable pertrochanteric fractures of the neck of the femur was subjected to either nail plating with 130 degrees neck-shaft angle or valgus osteotomy using a neck-shaft angle of at least 140 degrees. The patients were assessed in terms of ability to walk and stability of fracture fixation. A clear superiority of valgus osteotomy over the controls was demonstrated in terms of fracture fixation, but the difference in terms of ability to walk was less remarkable.