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MUSCULOSKELETAL SURGERY
Published in: MUSCULOSKELETAL SURGERY 1/2016

01-04-2016 | Original Article

How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System

Authors: R. Pascarella, R. Fantasia, A. Maresca, C. Bettuzzi, L. Amendola, S. Violini, F. Cuoghi, P. Sangiovanni, S. Cerbasi, S. Boriani, D. S. Tigani

Published in: MUSCULOSKELETAL SURGERY | Issue 1/2016

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Abstract

Purpose

The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails.

Methods

The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail.

Results

The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group.

Conclusion

The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.
Literature
1.
Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatric Soc 51:364–370CrossRef
2.
Weller I, Wai EK, Jaglal S et al (2005) The effect of hospital type and surgical delay on mortality after surgery for hip fracture. JBJS Br 87:361–366CrossRefPubMed
3.
4.
Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, IOF Working Group on Epidemiology and Quality of LifeGoEaQo (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2259CrossRefPubMedPubMedCentral
5.
White SM, Griffiths R (2011) Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury 42(11):1230–1233CrossRefPubMed
6.
7.
Thakar C, Alsousou J, Hamilton TW, Willett K (2010) The cost and consequences of proximal femoral fractures which require further surgery following initial fixation. J Bone Joint Surg Br 92:864–866
8.
Palmer SJ, Parker MJ, Hollingworth W (2000) The cost and implications of reoperation after surgery for fracture of the hip. J Bone Joint Surg Br 82:864–866CrossRefPubMed
9.
Parker MJ, Handoll HH (2002) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev 4:CD000093
10.
Sehat K, Baker RP, Pattison G, Price R, Harries WJ, Chesser TJS (2005) The use of the long gamma nail in proximal femoral fractures. Injury 36:1350–1354CrossRefPubMed
11.
Simpson AHRW, Varty K, Dodd CAF (1989) Sliding hip screws: modes of failure. Injury 20:22–231CrossRef
12.
Tencer AF, Johnson KD, Johnston DWC, Gill K (1984) A biomechanical comparison of various methods of stabilization of subtrochanteric fracture of the femur. J Orthop Res 2:297–305CrossRefPubMed
13.
Anglen JO, Weinstein JN (2008) Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice—a review of the American Board of Orthopaedic Surgery Database. JBJS Am 90(4):700–707CrossRefPubMed
14.
15.
Pascarella R, Cappuccio M, Maresca A, Borgogno E, Boriani S (2008) Gamma standard, Gamma Short, Gamma 3: comparison of three generations. GIOT 34:6–12
16.
17.
Halder SC (1992) The Gamma nail for peritrochanteric fractures. JBJS Br 74(3):340–344PubMed
18.
Utrilla AL, Reig JS, Muniz FM, Tufanisco CB (2005) Gamma versus DHS nailing for extracapsular femoral fractures. Meta analysis of ten randomized trials. Int Orthop 20(3):163–168
19.
Baumgarertner MR, Curtin SL, Lindskog DM, Keggi JM (1995) The value of the tip-apex distance in predicting failure of fixation of pertrochanteric fractures of the hip. JBJS Am 77:1058–1064
20.
Georgiannos D, Lampridis V, Bisbinas I (2014) Complications following treatment of trochanteric fractures with the Gamma 3 nail: is the latest version of gamma nail superior to its predecessor? Hindawi Publishing Corporation Surgery Research and Practice 2014:Article ID 143598. doi:10.​1155/​2014/​143598
21.
22.
Kyle RF, Gustilo RB, Premer RF (1979) Analysis of six hundred and twenty two intertrochanteric hip fractures. JBJS Am 61(2):216–221PubMed
23.
Nuchtern JV, Ruecker AH, Sellenschloh K et al (2014) Malpositioning of the lag screws by 1- or 2-screw nailing systems for perthrocanteric femoral fractures: a biomechanical comparison of gamma 3 and intertan. J Orthop Trauma 28(5):276–282. doi:10.​1097/​BOT.​0000000000000008​ CrossRefPubMed
24.
Zuzyk P, Zdero R, Shah S et al (2012) Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma 26(7):414–421CrossRef
25.
Wu CC, Shih CH (1991) Biomechanical analysis of the dynamic hip screw in the treatment of intertrochanteric fractures. Arch Orthop Trauma 110(6):307–310CrossRef
26.
Kawaguchi S, Sawada K, Nabeta Y (1998) Cutting out of the lag screw after internal fixation with the Asiatic gamma nail. Injury 29(1):47–53CrossRefPubMed
27.
Abram SG, Pollared TCB, Andrade AJMD (2013) Inadequate three point proximal fixation predicts failure of the Gamma Nail. JBJS 95:825–830
28.
Geller JA, Saifi C, Morrison TA, Macaulay W (2009) Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. JBJS Am 34:719–722
29.
Andruszkow H, Frinl M, Fromke C et al (2012) Tip apex distance, hip screw placement, and neck shaft angle as a potential risk factors for cut out failure of hip screws after surgical treatment of interthrocanteric fractures. Int Orthop SICOT 36:2347–2354. doi:10.​1007/​s00264-012-1636-0 CrossRef
30.
31.
Bartonicek J, Fric V, Skala-Rosenbaum J, Dousa P (2007) Avascular necrosis of the femoral head in pertrochanteric fractures: a report of 8 cases and a review of the literature. J Orthop Trauma 21(4):229–236CrossRefPubMed
32.
33.
34.
Parker MJ, Handoll HH (2010) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 8(9):CD000093. doi:10.​1002/​14651858.​CD000093
35.
36.
Shen L, Zhang Y, Chen Y et al (2013) Antirotation proximal femoral nails versus dynamic hip screw for interthrocanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res 99:377–383CrossRefPubMed
37.
Winnock de Grave P, Tampere T, Byn P et al (2012) intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs (A prospective randomized clinical trial). Int Orthop 78:192–198
38.
Bhandari M, Schemitsch E, Jonsson A et al (2009) Gamma nails revisited: gamma nails versus compression hip screws in the management of intertrochanteric fracture of the hip: a meta analysis. J Orthop Trauma 23(6):460–464CrossRefPubMed
39.
40.
Nordin S, Zufkifli O, Faisham WI (2003) Mechanical failure of Dynamic Hip Screw (DHS) fixation in interthrocanteric fracture of the femur. Med J Malaysia 56(Suppl D):12–17
41.
Davis TR, Sher JL, Horsman A et al (1990) Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg 72(1):26–31
42.
Kukla C, Heinz T, Gaebler C et al (2001) The standard gamma nail: a critical analysis of 1000 cases. J Trauma 51(1):77–83CrossRefPubMed
43.
Utrilla AL, Reig JS, Munoz FM et al (2005) Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma 19(4):229–233CrossRefPubMed
44.
Wolfgang GL, Bryant MH, O’Neill JP (1982) Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop 163:148–158PubMed
45.
46.
Hofer M, Chevalley F, Garofalo R et al (2006) Use of trochanteric nail for proximal femoral extracapsular fractures. Orthopaedics 29(12):1109–1114
47.
Bjorguul K, Reikeras O (2007) Outcome after treatment of complications of gamma nailing: a prospective study of 554 trochanteric fracture. Acta Orthopaedica 78(2):231–235CrossRef
48.
Schipper LB, Steyerberg EW, Castelein RM et al (2004) Treatment of unstable trochanteric fractures. Randomized comparison of the gamma nail and the proximal femoral nail. JBJS Br 86(1):86–94PubMed
49.
50.
Iwakura T, Niikura T, Yang Lee S, et al (2013) Breakage of a third generation Gamma nail: a case report and review of the literature. Case Reports in Orthopaedics 2013:Article ID 172352. doi:10.​1155/​2013/​172352
51.
De Grave PW, Tampere T, Byn P et al (2012) Intramedullary fixation of interthrocanteric hip fractures: a comparison of two implants designs. A prospective randomized clinical trial. Acta Orthop Belg 78:192–198
52.
Albareda J, Laderiga A, Palanca D et al (1996) Complications and technical problems with the gamma nail. Int Orthop 20(1):47–50CrossRefPubMed
53.
Kukla C, Heinz T, Gaebler C et al (2001) The standard gamma nail: a critical analysis of 1,000 cases. J Trauma 51(1):77–83CrossRefPubMed
54.
Butt MS, Kikler SJ, Nafie S et al (1995) Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury 26(9):615–618CrossRefPubMed
55.
Varela- Egocheaga JR, Iglesias-Colao R, Suarez-Suarez MA et al (2009) Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail. Arch Orthop Trauma Surg 129(10):1401–1407CrossRefPubMed
56.
Xu Y, Geng D, Yang H, Wang X, Zhu G (2010) Treatment of unstable proximal fractures: comparison of the proximal femoral nail antirotation and gamma 3 nail. Orthopaedics 33(7):473
57.
Norris R, Bhattacharjee D, Parker MJ (2012) Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury. doi:10.​1016/​j.​injury.​2011.​10.​027
58.
Aune AK, Ekeland A, Odegaard B, Grogaard B, Alho A (1994) Gamma nail vs compression screw for throcanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients. Acta Orthop Scand 65(2):127–130CrossRefPubMed
59.
Leung KS, Chen CM, So WS, Sato K et al (1996) Multicenter trial of modified Gamma nail in East Asia. Clin Orthop 323:146–154CrossRefPubMed
60.
Lacroix H, Arwert H, CJ Snijders, Fontijne WP (1995) Prevention of fracture at the distal locking site of the gamma nail: a biomechanical study. J Bone Joint Surg Br 77(2):274–276PubMed
Metadata
Title
How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System
Authors
R. Pascarella
R. Fantasia
A. Maresca
C. Bettuzzi
L. Amendola
S. Violini
F. Cuoghi
P. Sangiovanni
S. Cerbasi
S. Boriani
D. S. Tigani
Publication date
01-04-2016
Publisher
Springer Milan
Published in
MUSCULOSKELETAL SURGERY / Issue 1/2016
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-015-0391-y

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