Seok Hyun Kweon; Churl Hong Chun; Jung Hwan Yang; Jin Young Park; Kyu Hwan Bae

doi:10.12671/jkfs.2009.22.2.85

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

Department of Orthopedic Surgery, School of Medicine, Wonkwang University, Iksan, Korea.

Address reprint requests to: Jung Hwan Yang, M.D. Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, 344-2, Shinyong-dong, Iksan 570-711, Korea. Tel: 82-63-859-1360, Fax: 82-63-852-9329, bakgom95@hanmail.net

• Received: August 31, 2008 • Accepted: March 9, 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

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.
Key words: Peritrochanteric fracture, Gamma nail, Complication

REFERENCES

1. Albareda J, Laderiga A, Palanca D, Paniagua L, Seral F. Complications and technical problems with the gamma nail. Int Orthop, 1996;20:47-50.Article PDF
2. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am, 1995;77:1058-1064.Article
3. Bellabarba C, Herscovici D Jr, Ricci WM. Percutaneous treatment of peritrochanteric fractures using the Gamma nail. Clin Orthop Relat Res, 2000;375:30-42.Article
4. 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;73:330-334.Article PDF
5. Curtis MJ, Jinnah RH, Wilson V, Cunningham BW. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation. Injury, 1994;25:99-104.Article
6. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Am, 1949;31:190-203.
7. Habernek H, Wallner T, Aschauer E, Schmid L. Comparison of ender nails, dynamic hip screws, and Gamma nails in the treatment of peritrochanteric femoral fractures. Orthopedics, 2000;23:121-127.
8. Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br, 1992;74:340-344.
9. Kim SY, Choi YC, Kim SJ, et al. Peritrochanteric fractures of the femur treated with gamma nail. J Korean Orthop Assoc, 2002;37:325-330.
10. 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.
11. Larsson S, Friberg S, Hansson LI. Trochanteric fractures. Influence of reduction and implant position on impaction and complications. Clin Orthop Relat Res, 1990;259:130-139.
12. Lee SH, Ha SH, Park SJ. The Asian-pacfic gamma nail for intertrochanteric fracture of the femur. J Korean Orthop Assoc, 1999;34:819-824.
13. Leung KS, Chen CM, So WS, et al. Multicenter trial of modified gamma nail in East Asia. Clin Orthop Relat Res, 1996;323:146-154.
14. Leung KS, Procter P, Robioneck B, Behrens K. Geometric mismatch of the Gamma nail to the Chinese femur. Clin Orthop Relat Res, 1996;323:42-48.
15. Lindsey RW, Teal P, Probe RA, Rhoads D, Davenport S, Schauder K. Early experience with the gamma interlocking nail for peritrochanteric fractures of the proximal femur. J Trauma, 1991;31:1649-1658.
16. Loch DA, Kyle RF, Bechtold JE, Kane M, Anderson K, Sherman RE. Forces required to initiate sliding in second-generation intramedullary nails. J Bone Joint Surg Am, 1998;80:1626-1631.
17. Mahaisavariya B, Laupattarakasem W. Cracking of the femoral shaft by the gamma nail. Injury, 1992;23:493-495.
18. Parker MJ, Pryor GA. Gamma versus DHS nailing for extracapsular femoral fractures. Meta-analysis of ten randomised trials. Int Orthop, 1996;20:163-168.
19. Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br, 1993;75:789-793.
20. Rantanen J, Aro HT. Intramedullary fixation of high subtrochanteric femoral fractures: a study comparing two implant designs, the Gamma nail and the intramedullary hip screw. J Orthop Trauma, 1998;12:249-252.
21. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am, 1970;52:457-467.
22. Utrilla AL, Reig JS, Muñoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma, 2005;19:229-233.
23. Valverde JA, Alonso MG, Porro JG, Rueda D, Larrauri PM, Soler JJ. Use of the gamma nail in the treatment of fractures of the proximal femur. Clin Orthop Relat Res, 1998;350:56-61.

Fig. 1

(A) Preoperative radiograph shows unstable intertrochanteric fracture of the femur.

(B) Postoperative radiograph shows good reduction, but lag screw was being superior position.

(C, D) Radiograph 13 months after operation showing a cut-out of the lag screw.

Fig. 2

(A) Initial radiograph shows reverse intertrochanteric fracture.

(B) Postoperative radiograph shows nonanatomic reduction.

(C) 13 month follow up, lag screw displaced backward and collapse, and varus deformity occurred.

Fig. 3

(A) Initial radiographs showed unstable intertrochanteric fracture.

(B) Postoperative radiographs shows nonanatomical reduction with medial displacement.

(C) The distal screw breakage was occurred after 17 month, but fracture was union.

Fig. 4

Lag screw position.

Table 1

Type of complication

^*Number of patient.

Table 2

Fracture pattern

^*Number of patient, ^†Complication case.

Table 3

Position of lag screw

^*Number of patient, ^†Complication case.

Table 4

Reduction state

^*Number of patient, ^†Complication case.

Table 5

Bone mineral density

^*Number of patient, ^†Complication case, ^‡Bone mineral density.

Table 6

Singh index

^*Number of patient, ^†Complication case.

Figure & Data

REFERENCES

Citations

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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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Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

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

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Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

Fig. 1 (A) Preoperative radiograph shows unstable intertrochanteric fracture of the femur. (B) Postoperative radiograph shows good reduction, but lag screw was being superior position. (C, D) Radiograph 13 months after operation showing a cut-out of the lag screw.

Fig. 2 (A) Initial radiograph shows reverse intertrochanteric fracture. (B) Postoperative radiograph shows nonanatomic reduction. (C) 13 month follow up, lag screw displaced backward and collapse, and varus deformity occurred.

Fig. 3 (A) Initial radiographs showed unstable intertrochanteric fracture. (B) Postoperative radiographs shows nonanatomical reduction with medial displacement. (C) The distal screw breakage was occurred after 17 month, but fracture was union.

Fig. 4 Lag screw position.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

Table 1

Type of complication

^*Number of patient.

Table 2

Fracture pattern

^*Number of patient, ^†Complication case.

Table 3

Position of lag screw

^*Number of patient, ^†Complication case.

Table 4

Reduction state

^*Number of patient, ^†Complication case.

Table 5

Bone mineral density

^*Number of patient, ^†Complication case, ^‡Bone mineral density.

Table 6

Singh index

^*Number of patient, ^†Complication case.

Table 1 Type of complication

^*Number of patient.

Table 2 Fracture pattern

^*Number of patient, ^†Complication case.

Table 3 Position of lag screw

^*Number of patient, ^†Complication case.

Table 4 Reduction state

^*Number of patient, ^†Complication case.

Table 5 Bone mineral density

^*Number of patient, ^†Complication case, ^‡Bone mineral density.

Table 6 Singh index

^*Number of patient, ^†Complication case.