Comparison of Gamma Nail and Locking Plate in Treatment of Intertrochanteric Fractures
Keywords:
Intertrochanteric femoral fractures, gamma nail, locking plateAbstract
Background and Objectives: The effective method for the surgical treatment of intertrochanteric femoralfractures has not been established. Two commonly used techniques are Gamma nail and locking plate. We performed
a retrospective study to compare these two treatment strategies.
Materials and Methods: A total of 42 patients were selected for review. Each patient was treated by one of the
two methods. Data including operative time, blood loss, pain scale, radiological result, Harris hip score and operative
complications were collected.
Results: Twenty-two patients were treated with Gamma nail and the rest (20) were treated with locking plate
fixation. Gamma nail group was associated with significantly shorter operative time and length of hospital stay, lesser
blood loss and lower postoperative pain (P < 0.05). There was no significant difference in Harris hip score,
radiological result and complications between the two groups.
Conclusion: Gamma nail technique is similar in effectiveness to the locking plate in the treatment of
intertrochanteric femoral fractures, but with a shorter operative time and hospital stay, lesser blood loss and lower
postoperative pain.
References
1. Campbell WC, Canale ST, Beaty JH. Campbell’s operative
orthopaedics. 11th ed. Philadelphia, PA: Mosby/Elsevier;
2008.
2. Paganini-Hill A, Chao A, Ross RK, Henderson BE. Exercise and
other factors in the prevention of hip fracture: the Leisure
World study. Epidemiology 1991;2(1):16-25.
3. Rockwood CA, Green DP, Bucholz RW. Rockwood and
Green’s fractures in adults. 7th ed. Philadelphia, PA: Wolters
Kluwer Health/Lippincott Williams & Wilkins; 2010.
4. Dhanwal DK, Cooper C, Dennison EM. Geographic variation
in osteoporotic hip fracture incidence: the growing
importance of asian influences in coming decades. J
Osteoporos 2010;2010:757102.
5. Khan N, Askar Z, Ahmed I. Intertrochanteric fracture of
femur; outcome of dynamic hip screw in elderly patients.
Professional Med J 2010;17:328-33.
6. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo
E. Pertrochanteric femoral fractures treated with a dynamic
hip screw or a proximal femoral nail: A randomized study
comparing post-operative rehabilitation. J Bone Joint Surg
(Br) 2005;87-B:76-81.
7. Klinger HM, Baums MH, Eckert M, Neugebauer R. A
comparative study of unstable per- and intertrochanteric
femoral fractures treated with dynamic hip screw (DHS) and
trochanteric buttress plate vs. proximal femoral nail (PFN)
ZentralblChir 2005;130(4):301-6.
8. Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric
fractures treated with a proximal femoral nail. Int Orthop
2001;25:298-301.
9. Banan H, Al-Sabti A, Jimulia T, Hart AJ. The treatment of
unstable, extracapsular hip fractures with the AO/ASIF
proximal femoral nail-our first 60 cases. Injury 2002;33:401-5.
10. Al-yassari G, Langstaff RJ, Jones JWM, Al-Lami M. The AO/
ASIF proximal femoral nail (PFN) for the treatment of unstable
trochanteric femoral fracture. Injury 2002;33:395-9.
11. Leung KS, Procter P, Robioneck B, Behrens K. Geometric
mismatch of the Gamma nail to the Chinese femur.
ClinOrthopRelat Res. 1996;323:42-48.
12. Hwang JH, Oh JK, Han SH, Shon WY, Oh CW. Mismatch
between PFNa and medullary canal causing difficulty in
nailing of the pertrochanteric fractures. Arch Orthop Trauma
Surg 2008;128:1443-6.
13. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ.
Biomechanics of locked plates and screws. J Orthop Trauma.
2004;18(8):488-93.
14. Kregor PJ, Obremskey WT, Kreder HJ, Swiontkowski MF.
Unstable pertrochanteric femoral fractures. J Orthop Trauma.
2005;19(1):63-6.
15. Whitelaw GP, Segal D, Sanzone CF, Ober NS, Hadley N.
Unstable intertrochanteric/subtrochanteric fractures of the
femur. ClinOrthopRelat Res 1990;(252):238-45.
16. Yong C, Tan C, Penafort R. Dynamic hip screw compared to
condylar blade plate in the treatment of unstable fragility
intertrochanteric fractures. Malays orthop J 2009;3:13-8.
17. Bridle Sh, Patel AD, Bircher M, Calvert PT. Fixation of
intertrochanteric fractures of the femur: a randomised
prospective comparison of the gamma nail and the dynamic
hip screw. J Bone Joint Surg [Br]1991;73:330-4.
18. Halder SC. The Gamma nail for pertrochanteric fracture. J
Bone Joint Surg [Br] 1992;74:340-4.
19. Parker MJ, Pryor GA. Gamma versus DHS nailing for
extracapsular femoral fractures: meta-analysis of ten
randomised trials. IntOrthop (SICOT) 1996;20:163-8.
20. Radford JP, Needoff M, Webb JK. A prospective randomised
comparison of the dynamic hip screw and the Gamma
locking nail. J Bone Joint Surg [Br] 1993;75:789-93.
21. Jalovaara P, Berglund-R_den M, Wingstrand H, Thorngren
KG. Treatment of hip fracture in Finland and Sweden.
ActaOrthop Scand 1992;63(5):531-5.
22. Yuming Y, Yong L, Weiping Z. A clinical therapeutic effect
analysis of LCP fixation for osteoporotic femoral
intertrochanteric fracture with Singh’s classification I, II. Chin
J Bone Joint Injury 2011;10:8.
23. Hasenboehler EA, Agudelo JF, Morgan SJ, Smith WR, Hak DJ,
Stahel PF. Treatment of complex proximal femoral fractures
with the proximal femur locking compressionplate.
Orthopedics 2007;30(8):618-23.
24. Li P, Yang H, Zheng L. Postoperative complications of
Dynamic hip screw and its prevention in the treatment of
intertrochanteric fracture. J Dalian Med Univ 2009;3:17.
orthopaedics. 11th ed. Philadelphia, PA: Mosby/Elsevier;
2008.
2. Paganini-Hill A, Chao A, Ross RK, Henderson BE. Exercise and
other factors in the prevention of hip fracture: the Leisure
World study. Epidemiology 1991;2(1):16-25.
3. Rockwood CA, Green DP, Bucholz RW. Rockwood and
Green’s fractures in adults. 7th ed. Philadelphia, PA: Wolters
Kluwer Health/Lippincott Williams & Wilkins; 2010.
4. Dhanwal DK, Cooper C, Dennison EM. Geographic variation
in osteoporotic hip fracture incidence: the growing
importance of asian influences in coming decades. J
Osteoporos 2010;2010:757102.
5. Khan N, Askar Z, Ahmed I. Intertrochanteric fracture of
femur; outcome of dynamic hip screw in elderly patients.
Professional Med J 2010;17:328-33.
6. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo
E. Pertrochanteric femoral fractures treated with a dynamic
hip screw or a proximal femoral nail: A randomized study
comparing post-operative rehabilitation. J Bone Joint Surg
(Br) 2005;87-B:76-81.
7. Klinger HM, Baums MH, Eckert M, Neugebauer R. A
comparative study of unstable per- and intertrochanteric
femoral fractures treated with dynamic hip screw (DHS) and
trochanteric buttress plate vs. proximal femoral nail (PFN)
ZentralblChir 2005;130(4):301-6.
8. Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric
fractures treated with a proximal femoral nail. Int Orthop
2001;25:298-301.
9. Banan H, Al-Sabti A, Jimulia T, Hart AJ. The treatment of
unstable, extracapsular hip fractures with the AO/ASIF
proximal femoral nail-our first 60 cases. Injury 2002;33:401-5.
10. Al-yassari G, Langstaff RJ, Jones JWM, Al-Lami M. The AO/
ASIF proximal femoral nail (PFN) for the treatment of unstable
trochanteric femoral fracture. Injury 2002;33:395-9.
11. Leung KS, Procter P, Robioneck B, Behrens K. Geometric
mismatch of the Gamma nail to the Chinese femur.
ClinOrthopRelat Res. 1996;323:42-48.
12. Hwang JH, Oh JK, Han SH, Shon WY, Oh CW. Mismatch
between PFNa and medullary canal causing difficulty in
nailing of the pertrochanteric fractures. Arch Orthop Trauma
Surg 2008;128:1443-6.
13. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ.
Biomechanics of locked plates and screws. J Orthop Trauma.
2004;18(8):488-93.
14. Kregor PJ, Obremskey WT, Kreder HJ, Swiontkowski MF.
Unstable pertrochanteric femoral fractures. J Orthop Trauma.
2005;19(1):63-6.
15. Whitelaw GP, Segal D, Sanzone CF, Ober NS, Hadley N.
Unstable intertrochanteric/subtrochanteric fractures of the
femur. ClinOrthopRelat Res 1990;(252):238-45.
16. Yong C, Tan C, Penafort R. Dynamic hip screw compared to
condylar blade plate in the treatment of unstable fragility
intertrochanteric fractures. Malays orthop J 2009;3:13-8.
17. Bridle Sh, Patel AD, Bircher M, Calvert PT. Fixation of
intertrochanteric fractures of the femur: a randomised
prospective comparison of the gamma nail and the dynamic
hip screw. J Bone Joint Surg [Br]1991;73:330-4.
18. Halder SC. The Gamma nail for pertrochanteric fracture. J
Bone Joint Surg [Br] 1992;74:340-4.
19. Parker MJ, Pryor GA. Gamma versus DHS nailing for
extracapsular femoral fractures: meta-analysis of ten
randomised trials. IntOrthop (SICOT) 1996;20:163-8.
20. Radford JP, Needoff M, Webb JK. A prospective randomised
comparison of the dynamic hip screw and the Gamma
locking nail. J Bone Joint Surg [Br] 1993;75:789-93.
21. Jalovaara P, Berglund-R_den M, Wingstrand H, Thorngren
KG. Treatment of hip fracture in Finland and Sweden.
ActaOrthop Scand 1992;63(5):531-5.
22. Yuming Y, Yong L, Weiping Z. A clinical therapeutic effect
analysis of LCP fixation for osteoporotic femoral
intertrochanteric fracture with Singh’s classification I, II. Chin
J Bone Joint Injury 2011;10:8.
23. Hasenboehler EA, Agudelo JF, Morgan SJ, Smith WR, Hak DJ,
Stahel PF. Treatment of complex proximal femoral fractures
with the proximal femur locking compressionplate.
Orthopedics 2007;30(8):618-23.
24. Li P, Yang H, Zheng L. Postoperative complications of
Dynamic hip screw and its prevention in the treatment of
intertrochanteric fracture. J Dalian Med Univ 2009;3:17.
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Published
2016-10-01
How to Cite
1.
Wutphiriya-angkul S. Comparison of Gamma Nail and Locking Plate in Treatment of Intertrochanteric Fractures. Thai J Surg [Internet]. 2016 Oct. 1 [cited 2024 Nov. 6];37(4). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/225983
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