Journal of Musculoskeletal Trauma

Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail: Seok Hyun Kweon, Churl Hong Chun, Jung Hwan Yang, Jin Young Park, Kyu Hwan Bae; J Korean Fract Soc 2009;22(2):85-90. Published online April 30, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.2.85

PURPOSE
We analyzed the complications of femoral peritrochanteric fractures treated with the Gamma nail to reduce its complications.
MATERIALS AND METHODS
We evaluated the complications among the 96 patients who were treated with the Gamma nail from January 2000 to May 2005. Mean follow-up period was 17.8 months and mean age was 75.2 years. We analysed the relationship between the complication and the fracture pattern, postoperative reduction status, position of the lag screw, bone density, displacement and tip-apex index (TAD).
RESULTS
The complications were presented in 12 cases (12.5%). Cut-out of lag screw were in 5 cases, varus deformity with short lag screw in 2 cases, metal breakage of distal screw in 1 case, breakage of drill bit intraoperatively in 1 case, superficial infection in 2 cases and deep infection in 1 case. 5 cases (4.2%) were required reoperation. All of the cut-out of lag screw showed increased TAD (tip apex distance) above 25 mm.
CONCLUSION
To reduce the complications of the Gamma nail, we need exact surgical technique, good positioning of the lag screw and choice of appropriate length for the lag screw.

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Effectiveness of the Valgus Reduction Technique in Treatment of Intertrochanteric Fractures Using Proximal Femoral Nail Antirotation
Ji-Kang Park, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Dong-Soo Kim, Kyoung-Jin Park, Byung-Ki Cho, Jung-Kwon Cha, Sang-Woo Kang
Journal of the Korean Orthopaedic Association.2013; 48(6): 441. CrossRef

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Comparative Study of Bipolar Hemiarthroplasty and Second Generation Intramedullary Nailing on Treatment of Elderly Unstable Peritrochanteric Femoral Fractures: Ho Hyun Yun, Gil Yeong Ahn, Il Hyun Nam, Gi Hyuk Moon, Jae Wook Lee, Jae Cheol Kim; J Korean Fract Soc 2006;19(2):128-134. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.128

Abstract: PURPOSE
To evaluate and compare the clinical and radiological outcome of bipolar hemiarthroplasty and second generation intramedullary nailing for elderly unstable peritrochanteric femoral fracutre.
MATERIALS AND METHODS
From January 2000 to July 2004, 56 elderly unstable peritrochanteric fractures were treated with a bipolar hemiarthroplasty (34 cases) or a ITST intramedullary nailing (22 cases). The fractures were classified using the OTA/AO classification. The clinical results were evaluated by walking capability, hip joint pain, and thigh pain. The radiological results were evaluated on the basis of the radiographs at follow-up.
RESULTS
In bipolar hemiarthroplasty group, The mean operation time was 134 minute, the mean blood loss was 648 ml. In intramedullary nailing group, The mean operation time was 103 minute, the mean blood loss was 386 ml. There were no different walking ability between prefracture and postoperative state in 22 cases (65%) of bipolar hemiarthroplasty group, 18 cases (80%) of intramedullary nailing group respectively. There were 5 cases (14%) hip joint pain in bipolar hemiarthroplasty group and 4 cases (18%) thigh pain in ITST intramedullary nailing group postoperatively.
CONCLUSION
Comparing the operation time, blood loss, and walking ability, ITST intramedullary nailing group show superior clinical outcomes than bipolar hemiarthroplasty group. However, The effort for decreasing postoperative thigh pain might be required.

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The Result of Proximal Femoral Nailing (PFN(R)) for Unstable Femoral Peritrochanteric Fracture: Seung Yong Lee, In Heon Park, Kyung Won Song, Sung Il Shin, Jin Young Lee, Jeong Hun Cha; J Korean Soc Fract 2003;16(2):143-147. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.143

Abstract PDF

PURPOSE
We have used the proximal femoral nailing (PFN(R)) to evaluate the result of treatment for unstable femoral peritrochanteric fractures.
MATERIALS AND METHODS
From December 2000 to December 2001, 20 patients who had femoral peritrochanteric fracture were treated with proximal femoral nail (PFN(R)) in our hospital. The mean duration of follow-up was 16.8 months and average age was 58.7 years old. We evaluated the ambulation time, bone union time, neck-shaft angle, neck screw sliding by follow-up radiography, and studied the intra-operative and post-operative complication.
RESULTS
The average ambulation time was 3.8 days, the mean bone union time was 20.9 weeks, the mean neck shaft angle was 130.2 degree at post-operative time and 128.8 degree at last follow-up time, and the average neck screw sliding distance was 4.1 mm. The intra-operative complication was rotation of proximal fracture fragment in 1 case and displacement of femoral greater trochanter in 2 cases at proximal reaming, and displacement of proximal fracture fragment in 1 case at femoral stem insertion. The post-operative complication was coxa vara deformity in 2 cases and superficial wound infection in 1 case.
CONCLUSION
We have conclude that the proximal femoral nail (PFN(R)) could appropriately treat the unstable femoral peritrochanteric fracture and we obtained satisfactory results.

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Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Dae Jung Huh
Hip & Pelvis.2013; 25(1): 51. CrossRef
Operative Treatment with ITST in Femur Trochanteric Fracture
Ki-Do Hong, Jae-Chun Sim, Sung-Sik Ha, Jae-Young Kim, Jung-Ho Kang, Kwang-Hee Park
Journal of the Korean Fracture Society.2008; 21(4): 274. CrossRef
Comparison Study of Intertrochanteric Fractures Treated with Intertrochanteric/subtrochanteric Fixation with a Standard vs a Mini-incision
Se Dong Kim, Oog Jin Sohn, Jae Ho Cho
Journal of the Korean Fracture Society.2008; 21(1): 1. CrossRef

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Use of Gamma Nail in Peritrochanteric Fractures of the femur : A comparative study of Asian-Pacific type with Standard-European type: Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Dong Kyu Shin, Young Joon Youn; J Korean Soc Fract 1999;12(4):786-791. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.786

Abstract PDF: PURPOSE
: The mismatch of the Standard Gammd nail(SU) in oriental people led to the modification of the delign of its femoral shaft component and use of the Asian-Pacific type(AP). We compared the clinical results of 2 groups of femoral peritrochanteric fractures treated with each type of Gamma nail.
MATERIALS and METHODS
: 65 cases of peritrochanteric fractures of the femur(AP 24 cases, SU 42 cases) were studied with regard to operation time, union time and complications. The cases in each group were similar in fracture pattern, degree of osteoporosis and time interval between trauma and operation.
RESULTS
There were no significant differencef between two groups in operation time, intraoperative blood loss, and union time. Lateral cortical fracture and nail breakage were not observed in AP group but lag screw cutout was more frequent in AP group(8%) than in SU group(2%), but other complications were similar in type and frequency between two groups.
CONCLUSION
: AP Camma nail showed somewhat improved matching with the configuration of Korean femora, but further modification of the design might be needed to solve remained problems such as nail protrusion above trochanter.

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The Gamma Nail for Unstable Peritrochanteric Fractures: Hong Jun Han, Hee Jun Yu; J Korean Soc Fract 1996;9(1):76-80. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.76

Abstract PDF

The Gamma nail was designed to treat unstable intertrochanteric and subtochanteric fractures with the theoretical advantages of a load-sharing compinent which could be implanted by a semi-closed procedure. We report a retrospective study of 27 unstable peritrochanteric fractures treated by the Gamma nail. Gamma nail were implanted with an average duration of anesthesia of 84 minutes and little intra-operative bleeding by a semi-closed technique. Complications were few, and clinically not implant except one case of femoral shaft fracture at the distal end of the nail which healed well fter treatment with Gamma nail and circlage wiring.

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Treatment of the Proximal Femoral Fractures with Proximal Femoral Nail Antirotation (PFNA)
Myung-Sik Park, Young-Jin Lim, Young-Sin Kim, Kyu-Hyung Kim, Hong-Man Cho
Journal of the Korean Fracture Society.2009; 22(2): 91. CrossRef
Treatment of Senile Osteoporotic Intertrochanteric Fracture using Proximal Femoral Nail
Dong-Hui Kim, Sang-Hong Lee, Young-Lae Moon, Jun-Young Lee, Kun-Sang Song
Journal of the Korean Fracture Society.2007; 20(3): 215. CrossRef

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A Comparison study of the Gamma nail and the Dynamic Hip Screw for Peritrochanteric Fractures: Dong Chul Lee, Sang Jae Lee; J Korean Soc Fract 1994;7(2):616-627. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.616

Abstract PDF

The peritrochanteric fractures had been very troublesome due to its complication in the treatment of the old patients in the pastdays. The Dynamic Hip Screw and the Gamma nail made the patients to mobilize early and decreased the complications. We have treated 44 cases of the peritrochanteric fractures using Gamma nail(25 cases) and Dynamic Hip Screw (19 cases) between Aug. 1989 and Nov 1993, and compared the results of each group. And obtained results were as follows 1. The traffic accident was constituted about one third proportion and unstable types of the peritrochanteric fractures were 25 cases among 44 cases(57%). 2. The Mean union time of the Gamma nail group was 10.4 weeks and the Dynamic Hip Screw group was about 13 weeks. There was statistically no significance in the mean union time between both groups. 3. There revealed significance(P<0.05) by statistical analysis in operation time, admission day, blood transfusion between both groups. 4. There revealed no signicance (p<0.05) by statistical analysis in degree of sliding of the lag screw and change of neck-shaft angle. 5. The complications in the Gamma nail group were varus in 3 cases and infection in 1 case, and in the Dynamic Hip Screw group there were varus in 3 cases, delayed union in 2 cases and refracture in 1 case.

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The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail
Jong-Oh Kim, Young-One Ko, Mi-Hyun Song
Journal of the Korean Fracture Society.2011; 24(1): 1. CrossRef

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A Comparison study of the Gamma Nail the Dynamic Hip Screw for Peritrochanteric Fractures: Jong In Im, Bu Hwan Kim, Gi Deug Lee; J Korean Soc Fract 1994;7(2):322-330. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.322

Abstract PDF: Early operative treatment of peritrochanteric fracture in geriatric patients is now accepted practice and numerous versions of a sliding nail-plate system are the most widely used implants. The Gamma nail was introduced for the treatment of peritrochanteric component and minimizing the surgical trauma. We have operated 46 cases and studied 30 cases were followed up over 1 year. At follow-up, all patients continued to ambulate and all fractures healed. and clinical results was satisfactory. But we experienced some technical problems and complications. Intraoperative complications included difficulty in securely placing the distal screws(1 patient) and small fracture of the base of the greater trochanter(2 patients). Postoperative complications included gluteal bursitis(3 patients), progressive varus deformity(3 patients), progressive varus deformity(3 patients), thigh & knee pain(2 patients), cutting out of the femoral head (1 patient), and a femoral shaft fracture through the distal locking screws following a fall. We had no cases of infection or nonunion. To minimize technical problems and complications, the following considerations are important. 1. Accurate preoperative templating is necessary. 2. Exact placement of the guide wire. It must enter the greater trochanter at the junction of its anterior third and posterior two-thirds, just lateral to its tip. 3. Selection of a nail 2mm narrower than the reamer was recommended. 4. Nail must be inserted by hand, not by hammering, along the medulla canal. 5. Lag screw must be inserted into femoral head deeply and avokd into superior part of head especially in severe porotic bone. 6. Subtrochanteric fractures extending to distal locking site are inapproprocate indication for standard Gamma-nailing. a spiral subtrochanteric fracture which cannot be reduced by a closed technique is managed with circumferential wiring with nimimal incision before nail is inserted. 7. Repeated check of device loosening is important, especially before distal locking screw insertion. Initial insertion of proximal part of distal screw is preferred and routine use of distal locking screws is prohibited. 8. Weighted bearing must be delayed when abnormal sliding of lag screw is noted before weight bearing and in severe osteoporosis with comminution.

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