First Experience and Complications With the Long Gamma Nail

Stapert, J. W. J. L.; Geesing, Christel L. M.; Jacobs, Peter B. Dunki; Wit, Ralph J. de; Vierhout, P.A.M.

doi:10.1097/00005373-199303000-00015

Cited by 52 publications

(18 citation statements)

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“…Die verhältnismäûig lange Operationszeit kann am ehesten auf die groûe Anzahl komplexer Frakturen mit der Notwendigkeit zur offenen Reposition zurückgeführt werden. Der relativ hohe Anteil an Ausbildungseingriffen hatte keine signifikanten Auswirkungen, was unterstreicht, daû sich dieses System zur Ausbildung zumindest unter der Voraussetzung der Anleitung durch einen Systemerfahrenen durchaus eignet [9,25,26] Das untersuchte Patientenkollektiv wird zum einen geprägt durch einen hohen Anteil alter und prä-bzw. multimorbider Patienten, unterscheidet sich aber von anderen Studien [4, 6±9, 12, 18, 26] Weitere und absolut ernst zu nehmende Komplikationen sind Thromboembolien, die in dieser ebenso wie in anderen Studien [1,8,15,25] trotz konsequenter und auch individuell adaptierter Prophylaxe mit niedermolekularem Heparin bei knapp 10 % der Patienten klinisch evident und jeweils dopplersonographisch gesichert wurden.…”

Section: Komplikationenunclassified

“…Brüche des Implantats sind äuûerst seltene Komplikationen [26] [24]. Anhand dieser und anderer Studien läût sich folgern, daû mit dem LGN bei den komplexeren Frakturen des subtrochanteren und diaphysären Bereichs ähn-liche Überlebensraten erreicht werden wie beim Standardgammanagel oder bei der totalendoprothetischen Versorgung der Hüfte [3,5,6,8,9,13,24].…”

Section: Komplikationenunclassified

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Der lange Gammanagel – Indikationen, Technik und Ergebnisse

Buhl

Bois

Lamadé

et al. 2000

Chirurg

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The introduction of the Gamma nail (GN) as an intramedullar implant for pertrochanteric femoral fractures that allowed full weight bearing decreased the death rate from 17% (methods without full weight bearing) to 6%. The long Gamma nail (LGN) is a logical supplement of the standard version, designed to treat unstable per-, subtrochanteric and segmental fractures. This study evaluated 44 consecutive operations. Seventy percent of the patients had to be classified ASA III and IV, due to their high morbidity. The median age was 73.5 years. Multiple injuries occurred in 30.2%. All fractures were considered unstable. Surgery was usually performed within 24 h. The median duration of the surgical treatment was 120 min. In five cases technical problems were observed. Radiological controls showed a good positioning of the head screw. Early complications consisted of four local wound infections, three of them deep infections with a osteomyelitis. Deep venous thrombosis was observed in four cases, two of which included a pulmonary embolism (conservative treatment). The 30-day death toll was 2.3% (one patient). The median survival time (using Kaplan-Meier) in the study was 46 months, compared to 80 months in a matched population. This difference has to be linked to high premorbidity. The median duration of admission was 15 days. Mobilisation with full weight bearing was theoretically possible in all cases, but additional injuries or preoperatively impaired walking ability prevented full mobilisation in 15 cases. Functional assessment uncovered a decrease in Merle d,Aubigne score of 26.7% due to an impaired walking ability. Seventy-three percent of the patients regained their preoperative social status. In conclusion the long Gamma nail is a universal, less invasive implant with high early weight bearing. It thus allows early remobilization and reduces lethality in the treatment of complex, unstable coxal fractures.

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Section: Komplikationenunclassified

Der lange Gammanagel – Indikationen, Technik und Ergebnisse

Buhl

Bois

Lamadé

et al. 2000

Chirurg

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“…Its theoretical advantages include a small exposure, reduced operating time and blood loss, early weight bearing and mobilization, reducing morbidity and death (1) - (3) . The fracture in the subtrochanteric region shows higher biomechanical stresses than the frac-ture occurring in the trochanteric region due to bending moment and compressive forces generated by body weight and hip musculature, which may result in a higher failure rate of the implant (4), (5) . In most finite element analyses of the proximal femur with the endoprosthetic joint replacement or fracture fixation in place, the femoral loading condition commonly consists of a joint reaction force applied to the femoral head and the abductor muscle force applied to the greater trochanter.…”

Section: Introductionmentioning

confidence: 99%

Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN)

Sitthiseripratip

Mahaisavariya

Suwanprateeb

et al. 2004

JSME Int. J., Ser. C

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The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

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“…To treat a fracture distal to a standard Gamma nail, which was inserted for a pathologic fracture, the senior author welded the proximal part of the Gamma nail on a Grosse-Kempf nail in 1989, this construction being the prototype of the long Gamma nail [15]. After some modifications the long Gamma nail turned into an 11-mm intramedullary nail with an antecurvation of 10°1 Figures 1a to 1d.…”

Section: Introductionmentioning

confidence: 99%