Share this Article
Yang YH, Wang YR, Jiang SD, Jiang LS
Correspondence: Prof Sheng-Dan Jiang, firstname.lastname@example.org
INTRODUCTION Proximal femoral nail antirotation (PFNA) and third-generation Gamma nail (Gamma 3) are widely used in the treatment of intertrochanteric fractures. However, it remains unclear which device achieves better clinical and radiographic outcomes when treating intertrochanteric fractures.
METHODS This study comprised 239 patients with intertrochanteric fractures treated with either PFNA or Gamma 3 for a minimum of 12 months. During surgery, the operative time, image intensifier time and amount of blood loss were recorded. Following surgery, we assessed reduction quality and implant position. At the final follow-up, postoperative complications, including femoral shaft fracture, cutout, reoperation, pneumonia, urinary tract infection, cerebral infarction, cardiac infarction and decubital ulcer, were recorded. In addition, walking ability was assessed using the Parker-Palmer mobility score.
RESULTS No difference was found in the operative time, image intensifier time and amount of blood loss between patients treated with PFNA and those treated with Gamma 3. The reduction quality of fractures treated with Gamma 3 was better than those treated with PFNA. However, there were no significant differences in implant position, walking ability and postoperative complications between the two groups. Although Gamma 3 resulted in better reduction quality, it did not provide any advantages in walking ability and postoperative complications when compared with PFNA.
CONCLUSION Therefore, we conclude that both PFNA and Gamma 3 are safe and reliable devices for the treatment of intertrochanteric fractures.
Keywords: intertrochanteric fractures, intramedullary fixation
Singapore Med J 2013; 54(8): 446-450; http://dx.doi.org/10.11622/smedj.2013152
|1. Wolfgang GL, Bryant MH, O'Neill JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop Relat Res 1982; 163:148-58.|
|2. Bannister GC, Gibson AG, Ackroyd CE, Newman JH. The fixation and prognosis of trochanteric fractures. A randomized prospective controlled trial. Clin Orthop Relat Res 1990; 254:242-6.|
| 3. Simpson AH, Varty K, Dodd CA. Sliding hip screws: modes of failure. Injury 1989; 20:227-31. |
| 4. Haentjens P, Lamraski G. Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient: a review. Disabil Rehabil 2005; 27:1167-80. |
| 5. Stappaerts KH, Deldycke J, Broos PL, et al. Treatment of unstable peritrochanteric fractures in elderly patients with a compression hip screw or with the Vandeputte (VDP) endoprosthesis: a prospective randomized study. J Orthop Trauma 1995; 9:292-7. |
| 6. Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 2005; 87:2186-92. |
| 7. Lenich A, Mayr E, Rüter A, Möckl Ch, Füchtmeier B. First results with the trochanter fixation nail (TFN): a report on 120 cases. Arch Orthop Trauma Surg 2006; 126:706-12. |
|8. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am 1959; 41-A:1399-408.|
|9. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tipapex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995; 77:1058-64.|
|10. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993; 75:797-8.|
| 11. Yaozeng X, Dechun G, Huilin Y, Guangming Z, Xianbin W. Comparative study of trochanteric fracture treated with the proximal femoral nail antirotation and the third generation of gamma nail. Injury 2010; 41:1234-8. |
| 12. Rubio-Avila J, Madden K, Simunovic N,Bhandari M. Tip to apex distance in femoral intertrochanteric fractures: a systematic review. J Orthop Sci 2013; 18:592-8. |
| 13. Andruszkow H, Frink M, Frömke C, et al. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hipscrews after surgical treatment of intertrochanteric fractures. Int Orthop 2012; 36:2347-54. |
| 14. Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop 2010; 34:719-22. |
| 15. Hsueh KK, Fang CK, Chen CM, et al. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop 2012; 34:1273-6. |
| 16. Leung KS, Procter P, Robioneck B, Behrens K. Geometric mismatch of the Gamma nail to the Chinese femur. Clin Orthop Relat Res 1996; (323):42-8. |
|17. Koval KJ, Sala DA, Kummer FJ, Zuckerman JD. Postoperative weightbearing after a fracture of the femoral neck or an intertrochanteric fracture. J Bone Joint Surg Am 1998; 80:352-6.|
|18. 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):150-9.|
| 19. van der Sluijs JA, Walenkamp GH. How predictable is rehabilitation after hip fracture? A prospective study of 134 patients. Acta Orthop Scand 1991; 62:567-72. |