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Reduced complication rates for unstable trochanteric fractures managed with third-generation nails: Gamma 3 nail versus PFNA

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Third-generation nails for the management of unstable trochanteric fractures were evaluated with regard to outcomes.

Patients and methods

A prospective observational study comparing the Gamma 3 nail and the Proximal Femoral Nail Antirotation (PFNA) in 106 unstable trochanteric fractures confirms the recently reported low intra- and postoperative complication rates from retrospective cohort studies.

Results

Studies of same generations of both intramedullary nail systems did not reveal significant differences in intra- or postoperative complications. Intraoperative dislocation during nail insertion occurred 7 times for the Gamma nail and 9 times for the PFNA. The standard PFNA had to be exchanged intraoperatively for a shorter one on two occasions. Superficial wound healing disorders and hematoma requiring revision were observed in four patients in the Gamma 3 nail group and in three patients in the PFNA group. No deep infections were documented. Mechanical complications required revision in four patients (7.5%) after Gamma nailing and in two patients (3.8%) after PFNA. Postoperative rotation of the head–neck fragment was observed for the Gamma nail in three patients, not in the PFNA group. This was not statistically significant (p = 0.08). There were neither incidences of cut out without renewed trauma nor intraoperative fracture or postoperative femoral fracture. Nonunion affected 1 of 18 patients in late follow-up (p = 0.3) in the Gamma 3 nail group.

Discussion

The Gamma 3 nail and the PFNA yielded comparable clinical results and significantly improved outcomes for unstable trochanteric fractures compared to older nail generations.

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Authors and Affiliations

  1. Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany

    Felix Bonnaire, Thomas Lein, Tim Fülling & Philipp Bula

  2. Diakonissenkrankenhaus Dresden, Holzhofgasse 29, 01099, Dresden, Germany

    Thomas Lein

  3. Klinikum Gütersloh, Reckenberger Str. 19, 33332, Dresden, Germany

    Philipp Bula

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  1. Felix Bonnaire
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Correspondence to Felix Bonnaire.

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Bonnaire, F., Lein, T., Fülling, T. et al. Reduced complication rates for unstable trochanteric fractures managed with third-generation nails: Gamma 3 nail versus PFNA. Eur J Trauma Emerg Surg 46, 955–962 (2020). https://doi.org/10.1007/s00068-019-01200-7

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