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

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

doi:10.1097/00005131-199410000-00001

Cited by 149 publications

(58 citation statements)

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“…While comparative studies between the Gamma nail and hip compression screw have shown that the Gamma nail was associated with significant learning curves [19], details of the learning curves have not previously been examined. The aim of this study was to delineate the learning curves of residents learning hip fracture surgery using the cephalomedullary nail, cannulated screw fixation and hemiarthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Learning curves in hip fracture surgery

Bjørgul

Novicoff

Saleh

2010

International Orthopaedics (SICOT)

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The aim of this study was to identify and characterise learning curves in hip fracture surgery. Operating times were collected and related to the number of procedures done by residents performing closed reduction and internal fixation using cannulated screws for intracapsular fractures of the hip and cephalomedullary nailing for trochanteric fractures, as well as hemiarthroplasty for displaced intracapsular fractures. The mean operating times decreased significantly for all four procedures studied, though at different rates. For cannulated screws, the mean duration of surgery decreased from 47.8 minutes to 30.1 minutes for procedures 21-25. For cephalomedullary nailing without distal locking, the mean operating time decreased from 73.3 minutes to 36.3 minutes. For cephalomedullary nailing with distal locking, the mean operating time decreased from 81.7 minutes to 56.9 minutes. The mean operating time for hemiarthroplasty decreased from 97.3 minutes to 66.0 minutes. Mean operating times decreased significantly for all procedures studied, though at different rates, indicating a unique learning curve for each procedure.

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Section: Introductionmentioning

confidence: 99%

Learning curves in hip fracture surgery

Bjørgul

Novicoff

Saleh

2010

International Orthopaedics (SICOT)

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“…Intramedullary fixation by nailing is more useful in unstable and reverse oblique patterns because it has better axial telescoping and rotational stability as it is a load shearing device [11] . The proximal femoral nail and intramedullary hip screw have their own complications like increased radiation risk, high cost and higher learning curve [14,15,16] . The disadvantages of arthroplasty include more extensive surgery and the frequent necessity to use calcar replacing [10,17] .…”

Section: Discussionmentioning

confidence: 99%

Results of DHS and bone grafting in primary nonunion of intertrochanteric patients in a rural setup

Babu¹,

Anand²,

Thanigai³

2017

Int. J. Orthop. Sci.

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Introduction: Intertrochanteric fractures commonly result in malunion and coxa vara if untreated. Primary nonunion of intertrochanteric fractures is a rare occurrence in young individuals. Treatment methods preserving the femoral head has better longevity than hip arthroplasty Literature regarding the outcome of dynamic hip screw fixation and bone grafting in these patients is limited. Methods: 15 patients who underwent DHS fixation with bone grafting for primary nonunion of intertrochanteric fractures in young patients were studied retrospectively. Their epidemiological profile, neck shaft angle, limb length, visual analog scale and modified harris hip score were recorded and compared. Time to union and complications were noted. Statistical analysis was done with paired student t test. Results: Average time to fracture union was 18 weeks. Limb length and neck shaft angle improved from 3.6cm shortening, 105 degrees to 0.5cm and 129 degrees respectively. Modified harris hip score showed statistically significant improvemet from 24.5 to 73.8. Conclusion: DHS is a good surgical option in primary nonunion of intertrochanteric fractures in patients with good bone stock. Because native femoral head is being retained, activities of daily living in these patients become near normal. Keywords: Nonunion intertrochanteric fracture, DHS, valgus fixation, femoral head preservation IntroductionIntertrochanteric fractures of hip occur in the metaphyseal portion of the proximal femur with rich blood supply. Their end result with conservative or operative fixation is usually union in varus or proper alignment. Nonunion of intertrochanteric fractures is rare occurrence. It can occur due to improper immobilization, inadequate immobilization, unstable fixation, unstable fracture patterns and poor bone quality like osteoporosis. The incidence of nonunion in intertrochanteric fractures is reported to be 1-2%. Hip arthroplasty is the treatment of choice in nonunions with poor bone quality and failed internal fixation. Preservation of femoral head is preferred in younger individuals with good bonestock. Primary nonunions can unite with fracture stabilization and bone grafting like any other nonunion. There is a paucity of studies which evaluate the functional outcome of primary nonunions being stabilized with DHS and bone grafted. This study is directed to find the results of such a femoral head retaining method particularly useful in Indian population. A large number of patients in the rural areas seek treatment from traditional bonesetters, who mainly use local herbal application and inadequate splinting in the treatment of these fractures. Consequently, many fractures result in malunion and a few in nonunion. Most of the reported nonunions have followed unsuccessful attempts at operative stabilization of fractures. The factors resulting in primary nonunion have not been dealt with in any study due to the rarity of nonunions and because of ethical issues.

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“…Fixation with dynamic hip screw is the most common technique in the literature and for most of the surgeons is gold standard as well (3)(4)(5). Failure of dynamic hip screws especially in unstable fractures led to the use of proximal femoral nails which were designed after 1990's (6)(7)(8). After 2000's proximal femoral nails have been revised and, because of their biomechanical advantages, preferred very commonly especially in the unstable hip fractures with medial calcar discontinuity.…”

Section: Discussionmentioning

confidence: 99%

“…After 2000's proximal femoral nails have been revised and, because of their biomechanical advantages, preferred very commonly especially in the unstable hip fractures with medial calcar discontinuity. However studies reporting complications related with this technique started to come out with the common use of these implants (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Reported complications are cut-out, medial migration of the lag screw, perforation of the femoral head, malunion in varus position, nonunion, avascular necrosis, implant failure, neurovascular injuries and stress fracture distal to the nail.…”

Section: Discussionmentioning

confidence: 99%

Pelvic Migration of Lag Screw Following Fixation of an Intertrochanteric Femur Fracture with Proximal Femoral Nail

Akçay¹,

Satoğlu²,

Çabuk³

et al. 2013

JAREM

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Intertrochanteric femur fractures are very common in patients over 65 years old who have prominent osteoporosis. Proximal femoral nails are preferred because of their biomechanical advantages in the treatment of these fractures especially if the fracture is unstable with medial calcar discontinuity. However, many complications associated with intramedullary fracture fixation have been described following common use of these implants. Here, we report a rare complication of a short intramedullary nail in which medial pelvic migration of the lag screw was detected at eighth week postoperatively. The patient was subsequently treated with lag screw removal. (JAREM 2013; 3: 44-6)

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

Cited by 149 publications

References 0 publications

Learning curves in hip fracture surgery

Learning curves in hip fracture surgery

Results of DHS and bone grafting in primary nonunion of intertrochanteric patients in a rural setup

Pelvic Migration of Lag Screw Following Fixation of an Intertrochanteric Femur Fracture with Proximal Femoral Nail

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