Skip Navigation
Skip to contents

J Musculoskelet Trauma : Journal of Musculoskeletal Trauma

Search
Advanced Search
OPEN ACCESS
mobile search button mobile menu button

Articles

Page Path
HOME > J Musculoskelet Trauma > Volume 34(2); 2021 > Article
Original Article Comparison of the U-Blade Gamma3 Nail and the Zimmer Natural Nail for the Treatment of Intertrochanteric Fracture
Jae Sung Suh, Hyung-Gon Ryu, Young Ju Roh, Dae Won Shin, Sang-Min Kim
Journal of Musculoskeletal Trauma 2021;34(2):57-63.
DOI: https://doi.org/10.12671/jkfs.2021.34.2.57
Published online: April 30, 2021
1Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
2Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea

prev next
  • 31 Views
  • 0 Download
  • 0 Crossref
  • 0 Scopus
prev next
Full Article

Download PDF Download PDF

Abstract

Purpose
This study was performed to compare the clinical results and radiological follow-up differences between intertrochanteric fractures treated with the U-blade Gamma3 nail or the Zimmer natural nail (ZNN).
Materials and Methods
The medical records of 129 cases diagnosed with an intertrochanteric frac-ture (90 cases of U-blade Gamma3 nail, 39 cases of ZNN) from July 2015 to December 2018 were reviewed. Patients were assigned to a U-blade Gamma3 nail (n=39) or a ZNN (n=39) group. To reduce selective bias, groups were subjected to Propensity score matching by age, body mass index, bone mineral density, and fracture type. Patients that met the following criteria were excluded; age <65 years, non-ambulatory, high energy or pathologic fracture, and a follow-up of <6 months. Operation times, estimated blood losses, preoperative and postoperative Koval grades, Harris hip score and radiological lag screw positions in the femoral head, reduction quality, cut-out, tip-apex distance (TAD), lag screw sliding distances, and times to union were compared.
Results
Clinical results were similar in the two groups, but lag screw TAD was significantly greater in Ublade Gamma3 nail group (23.4 mm vs. 21.0 mm) (p=0.042). One case of cut-out occurred in the Ublade Gamma3 nail group, but no other nail-related postoperative complication was noted.
Conclusion
No significant difference was observed between the outcomes of U-blade Gamma3 nail or ZNN treatments of intertrochanteric fractures. We conclude that the U-blade confers no specific advan-tage.


J Korean Fract Soc. 2021 Apr;34(2):57-63. Korean.
Published online Apr 23, 2021.
https://doi.org/10.12671/jkfs.2021.34.2.57
Copyright © 2021 The Korean Fracture Society. All rights reserved.
Original Article

Comparison of the U-Blade Gamma3 Nail and the Zimmer Natural Nail for the Treatment of Intertrochanteric Fracture

Jae Sung Suh, M.D., Ph.D., Hyung-Gon Ryu, M.D., Young Ju Roh, M.D., Dae Won Shin, M.D. and Sang-Min Kim, M.D., Ph.D.*
    • Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea.
    • *Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea.
  • Correspondence to: Hyung-Gon Ryu, M.D. Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul 02053, Korea. Tel: +82-2-2276-7000, Fax: +82-2-2276-7100, Email: hg400@seoulmc.or.kr
Received December 30, 2020; Revised February 06, 2021; Accepted March 11, 2021.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was performed to compare the clinical results and radiological follow-up differences between intertrochanteric fractures treated with the U-blade Gamma3 nail or the Zimmer natural nail (ZNN).

Materials and Methods

The medical records of 129 cases diagnosed with an intertrochanteric fracture (90 cases of U-blade Gamma3 nail, 39 cases of ZNN) from July 2015 to December 2018 were reviewed. Patients were assigned to a U-blade Gamma3 nail (n=39) or a ZNN (n=39) group. To reduce selective bias, groups were subjected to Propensity score matching by age, body mass index, bone mineral density, and fracture type. Patients that met the following criteria were excluded; age <65 years, non-ambulatory, high energy or pathologic fracture, and a follow-up of <6 months. Operation times, estimated blood losses, preoperative and postoperative Koval grades, Harris hip score and radiological lag screw positions in the femoral head, reduction quality, cut-out, tip-apex distance (TAD), lag screw sliding distances, and times to union were compared.

Results

Clinical results were similar in the two groups, but lag screw TAD was significantly greater in U-blade Gamma3 nail group (23.4 mm vs. 21.0 mm) (p=0.042). One case of cut-out occurred in the U-blade Gamma3 nail group, but no other nail-related postoperative complication was noted.

Conclusion

No significant difference was observed between the outcomes of U-blade Gamma3 nail or ZNN treatments of intertrochanteric fractures. We conclude that the U-blade confers no specific advantage.

Keywords
Femur, Intertrochanteric fractures, U-blade Gamma3 nail, Zimmer natural nail

Figures

Fig. 1
(A) Anteroposterior view of an intertrochanteric fracture treated with a U-blade Gamma3 nail. (B) Trans-Lateral view of an intertrochanteric fracture treated with a U-blade Gamma3 nail. (C) Photograph of a U-blade Gamma3 nail.

Fig. 2
(A) Anteroposterior view of an intertrochanteric fracture treated with a Zimmer natural nail. (B) Trans-lateral view of an intertrochanteric fracture treated with a Zimmer natural nail. (C) Photograph of a Zimmer natural nail.

Fig. 3
(A, B) Preoperative anteroposterior and trans-lateral radiographs of an intertrochanteric fracture in a 97-year-old man classified as AO A2.2. (C, D) Postoperative anteroposterior and translateral radiographs showing the U-blade Gamma3 nail.

Fig. 4
(A) Anteroposterior radiographs taken at one year postoperatively of a 97-year-old man treated with a U-blade Gamma3 nail showing fixation failure and blade cut-out through the femoral head into the acetabulum. (B) Revision total hip arthroplasty enabled the patient to walk independently.

Tables

Table 1
Demographic Characteristics

Table 2
Comparison of Clinical Results

Table 3
Comparison of the Radiographic Results

Notes

Financial support:None.

Conflict of interests:None.

References

    1. Kyle RF, Cabanela ME, Russell TA, et al. Fractures of the proximal part of the femur. Instr Course Lect 1995;44:227–253.
    1. Lee YS, Huang HL, Lo TY, Huang CR. Dynamic hip screw in the treatment of intertrochanteric fractures: a comparison of two fixation methods. Int Orthop 2007;31:683–688.
    1. Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: a meta-analysis. Orthop Traumatol Surg Res 2014;100:859–866.
    1. Niu E, Yang A, Harris AH, Bishop J. Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the United States? A survey of orthopaedic surgeons. Clin Orthop Relat Res 2015;473:3647–3655.
    1. Dávid A, von der, Pommer A. [Therapeutic possibilities in trochanteric fractures. Safe--fast--stable]. Orthopade 2000;29:294–301.
      German.
    1. Friedl W, Clausen J. [Experimental examination for optimized stabilisation of trochanteric femur fractures, intra- or extramedullary implant localisation and influence of femur neck component profile on cut-out risk]. Chirurg 2001;72:1344–1352.
      German.
    1. Kempf I, Grosse A, Taglang G, Favreul E. [Gamma nail in the treatment of closed trochanteric fractures. Results and indications apropos of 121 cases]. Rev Chir Orthop Reparatrice Appar Mot 1993;79:29–40.
      French.
    1. Yoo J, Kim S, Jung H, Hwang J. Clinical outcomes of U-blade Gamma3 nails used to treat patients with trochanteric fractures: retrospective multicenter study. Hip Pelvis 2019;31:95–101.
    1. Lenich A, Vester H, Nerlich M, Mayr E, Stöckle U, Füchtmeier B. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip--blade vs screw. Injury 2010;41:1292–1296.
    1. Lang NW, Arthold C, Joestl J, et al. Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail. Injury 2016;47:2733–2738.
    1. Shin YS, Chae JE, Kang TW, Han SB. Prospective randomized study comparing two cephalomedullary nails for elderly intertrochanteric fractures: Zimmer natural nail versus proximal femoral nail antirotation II. Injury 2017;48:1550–1557.
    1. 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):150–159.
    1. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An endresult study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737–755.
    1. Corrales LA, Morshed S, Bhandari M, Miclau T 3rd. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am 2008;90:1862–1868.
    1. Kashigar A, Vincent A, Gunton MJ, Backstein D, Safir O, Kuzyk PR. Predictors of failure for cephalomedullary nailing of proximal femoral fractures. Bone Joint J 2014;96-B:1029–1034.
    1. Queally JM, Harris E, Handoll HH, Parker MJ. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2014;(9):CD004961.
    1. Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury 2009;40:428–432.
    1. Chinzei N, Hiranaka T, Niikura T, et al. Comparison of the sliding and femoral head rotation among three different femoral head fixation devices for trochanteric fractures. Clin Orthop Surg 2015;7:291–297.
    1. Sommers MB, Roth C, Hall H, et al. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma 2004;18:361–368.
    1. Han SB, Jung JK, Jang CY, Kwak DK, Kim JW, Yoo JH. Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures. Sci Rep 2020;10:6021.
  • Cite
    CITE
    export Copy Download
    Close
    Download Citation
    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
    Format:
    • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
    • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
    Include:
    • Citation for the content below
    Comparison of the U-Blade Gamma3 Nail and the Zimmer Natural Nail for the Treatment of Intertrochanteric Fracture
    J Korean Fract Soc. 2021;34(2):57-63.   Published online April 30, 2021
    DOI: https://doi.org/10.12671/jkfs.2021.34.2.57
    Close
J Musculoskelet Trauma : Journal of Musculoskeletal Trauma
© The Korean Fracture Society.
Close layer
TOP