A Prospective Comparative Study of the Compression Hip Screw and the Gamma Nail

Goldhagen, Paul R.; OʼConnor, Daniel R.; Schwarze, Daniel; Schwartz, Elliot

doi:10.1097/00005131-199304000-00090

Cited by 7 publications

(9 citation statements)

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“…Operative treatment is the gold standard provided there are no contraindications. Intramedullary devices have enjoyed considerable success rate in osteoporotic fractures with lower incidence of cutout as well good outcomes following their use in unstable fractures [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Proximal femoral nail antirotation (PFNA) for treatment of osteoporotic proximal femoral fractures

Raviraj

Anand

Chakravarthy

et al. 2011

Eur J Orthop Surg Traumatol

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Background Unstable trochanteric fractures have been an enigma for the orthopedic surgeon in the community because of unpredictable results. Cephalic intramedullary nails with proximal antirotation device are the treatment of choice for such patients. Purpose To report outcomes of 36 consecutive patients treated with a proximal femoral nail (PFNA) for osteoporotic trochanteric femoral fractures. Methods The patients included 20 men and 16 women, aged 55-78 years (mean 65.3 years) years with trochanteric/proximal femoral fractures, which underwent PFNA fixation using an intramedullary nail and a spiral blade into the femoral head. We used AO system of classification of the fractures. Pertrochanteric (31 A1 and 31 A2), intertrochanteric fractures (31 A3), and high subtrochanteric (32 A1) fractures were included in the study. We had 16 A2 fractures, 12 A3 fractures, and 6 A1 fractures and 2 cases of 32 A1 fractures. 31 A2 was the commonest type. The operative time, the overall fluoroscopy time, intraoperative blood loss, the duration of hospitalization, and the surgical complications were noted. Patients were followed up for a mean of 24 months (range 18-36 months). Functional outcomes were assessed according to the Harris hip scoring system. ResultsOne patient required open reduction. The mean duration of surgery was 45 min (range 25-55 min). The mean image intensifier usage time was 70 ms with a range between 44 and 98 ms. The mean time of hospital stays was 5 days (4-10). Postoperative radiographs showed good reduction in 32 cases (out of 34) or acceptable in the 2 cases. There were three postoperative complications (one myocardial infarction, one patient developed DVT, and one patient developed bedsore). There were no cutouts of the spiral blade. Two patients expired due to medical illness unrelated to the fracture. All 34 patients available for follow-up had healed fractures without any implant-related complications, such as bending, breaking, or implant cutout. The average bone healing time was 18 weeks (12-22 weeks). At the time of the latest follow-up, all the 34 patients were full weight bearing on affected site, with return to their preinjury activity level. The mean Harris hip score was 96.4 points (range 69-100 points). A total of 32 patients had excellent or good outcome, and 2 patients had satisfactory outcome and none had poor outcome. Conclusion PFNA is useful for the treatment of osteoporotic proximal femoral fractures, and our initial experience suggest that it has low implant-related complications.

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Section: Introductionmentioning

confidence: 99%

Proximal femoral nail antirotation (PFNA) for treatment of osteoporotic proximal femoral fractures

Raviraj

Anand

Chakravarthy

et al. 2011

Eur J Orthop Surg Traumatol

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“…In a comparative study on the compression hip screw and the gamma nail, Goldhagen and associates [19] noted a significant learning curve in the use of the gamma nail. In a retrospective study over 8 years Hesse et al [8] reported 387 patients treated by gamma nail between 1992 and 2000.…”

Section: Cephalomedullary Nailingmentioning

confidence: 99%

Intramedullary Stabilization of Proximal Femoral Fractures

Hajdu

Vécsei

2007

Eur J Trauma Emerg Surg

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For nearly 40 years, extramedullary stabilization using the sliding hip screw and plate has been the standard fixation method for proximal femoral fractures. In patients with stable fractures, this device produces excellent results. However, in patients with unstable fractures, the sliding hip screw and plate is associated with an increased prevalence of complications, particularly cut-out, medialization of the shaft, shortening, and subsequent loss of reduction. For these reasons, there has been a sustained interest in the use of an intramedullary nail to treat proximal femoral fractures. However, intramedullary methods of therapy for trochanteric fractures require extensive operative experience. The incidence of complications, e.g. cut-out, femoral shaft fractures, and the learning curve has resulted in a loss off popularity of these devices in the past. The aim of this overview is to analyze and record the current standards by means of recent papers and to present the experience after intramedullary stabilization of more than 3,000 patients with proximal femoral fractures at our level I trauma center.

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“…Randomisierte, prospektive klinische Studien zeigen keinen Unterschied in den Resultaten nach unterschiedlichen Versorgungen [1,13], (Tabelle 1). Bei Einsatz der DHS genügt in der Regel eine 2 Loch Platte (Abb.…”

Section: A1-frakturunclassified

“…Die hochinstabilen A3-Frakturen sollten zunehmend mit intramedullären Implantaten versorgt werden [6,11,12,13,14]. Hierzu eignen sich der GammaNagel sowie der proximale Femurnagel (PFN), mit dem jedoch noch recht wenige Erfahrungen bestehen.…”

Section: A2-und A3-frakturenunclassified