Published online Jan 17, 2013.
https://doi.org/10.12671/jkfs.2013.26.1.37
Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail
Abstract
Purpose
To compare the result between the third generation gamma nail (gamma 3 nail) and proximal femoral nail anti-rotation (PFNA) in the treatment of unstable intertrochanteric fractures.
Materials and Methods
Between March 2009 and June 2011, 47 consecutive patients with unstable intertrochanteric femoral fractures were treated with gamma 3 nail or PFNA. We reviewed 24 cases of gamma 3 nail and 23 cases of PFNA. Retrospectively, we evaluated the mean operation time, amount of bleeding, average union period, reduction status, change of neck shaft angle, Tip-apex distance, Cleveland index, sliding of lag screw and complication on set of telephone interview and outpatient. We also evaluated the postoperative capability of function and mobility, using 'Modified Koval index'.
Results
There were no significant differences between the groups, which were treated with gamma 3 nail and PFNA. In addition, they did not show statistical difference. We experienced 2 cases of complication (gamma 3 nail 1 case, PFNA 1 case), which were cut-out of the femoral head.
Conclusion
The gamma 3 nail and PFNA were seen with good results in the treatment of unstable intertrochanteric fracture.
Fig. 1
Gamma 3 nail using sure shot guide of gamma 3 nail help determine correct nail positioning to allow proper placement of the lag screw.
Fig. 2
(B) Postoperative radiograph which is fixed with gamma 3 nail. (C) Lateral view of postoperative radiograph. (D) Postoperative 2 weeks radiograph shows cutting out of the lag screw. (E) Postoperative 12 weeks radiographs show a aggravation of cut-out complication (Patient refused a re-operation.).
(A) A 85-year-old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.3.
Fig. 3
(B) Postoperative radiograph which is fixed with proximal femoral nail anti-rotation (PFNA). (C) Lateral view of postoperative radiograph. (D) Postoperative 6 months radiograph shows cutting out of the PFNA blade. (E) Reoperation was done with cemented bipolar hemiarthroplasty.
(A) A 59-year-old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.2.
Table 1
Demographic Characteristics between the Group 1 and 2
Table 2
Immediately Postoperative Reduction Status
Table 3
Comparison of Radiographic Results
Table 4
Comparison of Dlinical Results
References
-
Hong KD, Sim JC, Ha SS, Kim TH, Choi YH, Kim JH. Operative treatment with gamma 3 nail in femur intertrochanteric fracture. J Korean Fract Soc 2011;24:7–15.
-
-
Kim TH, Kim JO, Lee SY, Yun GU. Treatment of the unstable intertrochanteric fracture with proximal femoral nail antirotation: comparison with compression hip screw with trochanteric stabilizing plate. J Korean Fract Soc 2010;23:353–359.
-
-
Koval KJ, Cantu RV. Intertrochanteric fractures. In: Rookwood CA Jr, Green DP, editors. Fractures in adults. 6th ed. Philadelphia: JB Lippincott; 2006. pp. 1793-1825.
-
-
Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res 1995;(310):150–159.
-
-
Kyle RF, Cabanela ME, Russell TA, et al. Fractures of the proximal part of the femur. Instr Course Lect 1995;44:227–253.
-
-
Lacroix H, Arwert H, Snijders CJ, Fontijne WP. Prevention of fracture at the distal locking site of the gamma nail. A biomechanical study. J Bone Joint Surg Br 1995;77:274–276.
-
-
Lee JY, Lee SY. Treatment of the proximal femoral extracapsular fracture with proximal femoral nail antirotation (PFNA): comparison with proximal femoral nail (PFN). J Korean Hip Soc 2007;19:183–189.
-
-
Müller ME, Nazarian S. Classification of fractures of the femur and its use in the A.O. index (author's transl). Rev Chir Orthop Reparatrice Appar Mot 1981;67:297–309.
-
-
Nunn D. Sliding hip screws and medial displacement osteotomy. J R Soc Med 1988;81:140–142.
-
-
Oh JK, Hwang JH. Osteoporotic pertrochanteric fracture: IM nailing. J Korean Fract Soc 2009;22:56–65.
-
-
Oh KJ, Lee ST, Lee SH, Hwang JH, Kang MS. Helical blade versus lag screw for treatment of intertrochanteric fracture. J Korean Fract Soc 2010;23:6–12.
-
-
Park JH, Park JW, Wang JH, Lee JW, Lee JI, Kim JG. Treatment of intertrochanteric fracture: comparison of proximal femoral nail and proximal femoral nail A. J Korean Fract Soc 2008;21:103–109.
-
-
Park MS, Lim YJ, Kim YS, Kim KH, Cho HM. Treatment of the proximal femoral fractures with proximal femoral nail antirotation (PFNA). J Korean Fract Soc 2009;22:91–97.
-
-
Templeman D, Baumgaertner MR, Leighton RK, Lindsey RW, Moed BR. Reducing complications in the surgical treatment of intertrochanteric fractures. Instr Course Lect 2005;54:409–415.
-