The Titanium Gamma Nail as Routine Treatment of Pertrochanteric Femoral Fractures

Abstract

A retrospective study was aimed at determining whether complications like cut-out and femoral shaft fracture, which are associated with the first-generation Gamma nail, could be diminished by using the improved, third-generation Gamma nail, the so-called titanium Gamma nail. The study described here consisted of 71 patients with pertrochanteric femur fracture that were treated operatively with the titanium Gamma nail in our clinic in 2001. The evaluation was carried out on the basis of patients' records, X-ray analyses and, in some cases, telephone interviews. Specific complications included one femoral-shaft fracture far below the nail and one mal-positioned femoral neck screw. No typical cut-out of the femoral neck screw occurred in any of the patients. The rates of complications not associated with the implant, e. g., wound infection, were comparable to those reported in the literature. Due to improvements of the implant, particularly of the femoral lag screw, and to improvements of the surgical instruments, the titanium Gamma nail is considered to be a safe implant for all fractures of the trochanteric region of the femur.

Key words

cut-out - lag screw - femoral shaft fracture - complications - implant failure - fixed-nail plate - sliding-screw plate

References

• 1 Al-Yassari G, Langstaff R J, Jones J WM, Al-Lami M. The AO/ASIF proximal femoral nail (PFN) for the treatment of unstable trochanteric femoral fracture.  Injury. 2002;  33 395-399
• 2 Banan H, Al-Sabti A, Jimulia T, Hart A J. The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail (PFN) - our first 60 cases.  Injury. 2002;  33 401-405
• 3 Bannister G C, Orth M C, Gibson A G, Ackroyd C E, Newman J H. The fixation and prognosis of trochanteric fractures.  Clin Orthop Rel Res. 1990;  254 242-246
• 4 Benum P, Grontvedt T, Braten M, Walloe A, Ekeland A, Raugstad S, Fasting O. Gamma nail versus CHS in intertrochanteric and subtrochanteric fractures: a preliminary report of a prospective randomized study.  Acta Orthop Scand. 1992;  63 (Suppl 247) 7-8
• 5 Bonnaire F, Götschin U, Kuner E H. Früh- und Spätergebnisse nach 200 DHS-Osteosynthesen zur Versorgung pertrochanterer Femurfrakturen.  Unfallchirurg. 1992;  95 246-253
• 6 Bonnaire F, Hellmund R, Lein T. DHS - Stärken und Schwächen der Platten-Schrauben-Kombinationen.  Trauma Berufskrankh. 2003;  5 (Suppl 2) 162-170
• 7 Brandt S E, Lefever S, Janzing H MJ, Broos P LO, Pilot P, Houben B JJ. Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results.  Injury. 2002;  33 413-418
• 8 Bridle S H, Patel A D, Bircher M, Calvert P T. Fixation of intertrochanteric fractures of the femur.  J Bone Joint Surg [Br]. 1991;  73 330-334
• 9 Chinoy M A, Parker M J. Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: a meta analysis of 14 studies.  Injury. 1999;  30 157-163
• 10 Davis T RC, Sher J L, Horsman A, Simpson M, Porter B B, Checketts R G. Intertrochanteric femoral fractures. Mechanical failure after internal fixation.  J Bone Joint Surg [Br]. 1990;  72 26-31
• 11 Fornander P, Thorngren K G, Törnqvist H, Ahrengart L, Lindgren U. A Swedish experience of the first 209 randomized patients with Gamma nail vs. screw plate.  Acta Orthop Scand. 1992;  63 (Suppl 248) 90
• 12 Friedl W, Colombo-Benkmann M, Dockter S, Machens H G, Mieck U. Gammanagel-Osteosynthese per- und subtrochanterer Femurfrakturen.  Chirurg. 1994;  65 953-963
• 13 Goldhagen P R, O'Connor D R, Schwarze D, Schwartz E. A prospective comparative study of the compression hip screw and the Gamma nail.  J Orthop Trauma. 1994;  8 367-372
• 14 Gonschorek O, Verheyden A P, Tiemann A, Josten C. Komplikationen mit dem proximalen Femurnagel.  Trauma Berufskrankh. 2003;  5 (Suppl 2) 171-174
• 15 Guyer P, Landoldt M, Eberle C, Keller H. Der Gamma-Nagel als belastungsstabile Alternative zur DHS bei der instabilen proximalen Femurfraktur des alten Menschen.  Helv Chir Acta. 1992;  58 697-703
• 16 Haidukewych G J, Israel T A, Berry D J. Reverse obliquity fractures of the intertrochanteric region of the femur.  J Bone Joint Surg [Am]. 2001;  83 643-650
• 17 Heinz T, Vécsei V. Komplikationen und Fehler bei der Anwendung des Gammanagels.  Chirurg. 1994;  65 943-952
• 18 Hoffmann R, Linskey T G. Intertrochanteric fractures of the femur; a randomized prospective comparison of the Gamma nail and the Ambi hip screw.  J Bone Joint Surg [Br]. 1993;  75 (Suppl 1) 50
• 19 Hoffmann R, Schmidmaier G, Schulz R, Schütz M, Südkamp N P. Classic-Nagel vs. Dynamische Hüftschraube (DHS).  Unfallchirurg. 1999;  102 182-190
• 20 Hogh J, Andersen K, Duus B, Hansen D, Hellberg S, Jakobsen B, Jensen J, Jensen P E, Mikkelsen S, Schroder H, Soelberg M. Gamma nail versus DHS in the treatment of trochanteric and subtrochanteric fractures.  Acta Orthop Scand. 1992;  63 (Suppl 248) 87
• 21 Karich B. Probleme mit dem γ-Nagel - Optimierungsmöglichkeiten.  Trauma Berufskrankh. 2003;  5 (Suppl 2) 175-183
• 22 Kaufer H. Mechanics of the treatment of hip injuries.  Clin Orthop. 1980;  146 53-61
• 23 Klanke J, Stepanek E, Westermann K. Injury of a branch of the arteria profunda femoris after a pertrochanteric femur fracture.  Osteo Trauma Care. 2002;  10 76-80
• 24 Manner M, Ruf W. Die dynamische Hüftschraube.  Unfallchirurg. 1988;  91 299-306
• 25 McLaren C AN, Buckley J R, Rowley D I. Intertrochanteric fractures of the femur: a randomized prospective trial comparing the Pugh nail with the dynamic hip screw.  Injury. 1991;  22 193-196
• 26 Mills H J, Horne G. Displacement of subcapital fractures during internal fixation: a real problem?.  Aust N Z J Surg. 1989;  59 249
• 27 Müller M E. Klassifikation und internationale AO-Dokumentation der Femurfrakturen.  Unfallheilkunde. 1980;  83 251-259
• 28 Parker M J, Pryor G A. Gamma versus DHS-nailing for extracapsular femoral fractures.  Int Orthop. 1996;  20 163-168
• 29 Parker M J, Handoll H HG. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures (Cochrane revue). In: The Cochrane Library, Issue 2, 2001. Update Software, Oxford, www.update-software.com/CLIP/CL…F = &H = &D = 1&L = 376N = 400&M = 1081&C = 398&T = *
• 30 Radford P J, Needoff M, Webb J K. A prospective randomised comparison of the dynamic hip screw and the Gamma locking nail.  J Bone Joint Surg [Br]. 1993;  75 789-793
• 31 Ragnarsson J I, Hansson L I, Karrholm J. Stability of femoral neck fractures. A postoperative roentgen stereophotogrammetric analysis.  Acta Orthop Scand. 1989;  60 283
• 32 Sabharval S, O'Brien P J, Meek R N, Blachut P, Broekhuyse H M. Intertrochanteric hip fracture fixation - Gamma versus dynamic hip screw. A randomized prospective study.  J Bone Joint Surg [Br]. 1992;  74 (Suppl 3) 281
• 33 Sim E, Berzlanovich A. The influence of biomechanically inadequate internal fixation on dynamic hip screws.  Osteo Trauma Care. 2002;  10 13-19
• 34 Simmermacher R KJ, Bosch A M, Werken C Van der. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures.  Injury. 1999;  30 327-332
• 35 Swiontkowski M F, Harrington R M, Keller T S, Patten P K Van. Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density.  J Orthop Res. 1987;  5 433
• 36 Valverde J A, Alonso M G, Porro J G, Ruede D, Larrauri P M, Soler J J. Use of the Gamma nail in the treatment of fractures of the proximal femur.  Clin Orthop Rel Res. 1998;  350 56-61