Gamma nail vs compression screw for trochanteric femoral fractures: 15 reoperations in a prospective, randomized study of 378 patients

Aune, Arne Kristian; Ekeland, Arne; Ødegaard, Bjørn; Grøgaard, Bjarne; Alho, A

doi:10.3109/17453679408995418

Cited by 124 publications

(57 citation statements)

References 16 publications

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“…Numerous studies have been published comparing sliding compression hip screw and side plate with IM fixation [2,12,16,17,29,31,32]. However, results have been contradictory in terms of outcomes [2,12,16,17,29,31,32] with the only consistent differences reported between the two fixation techniques being increased complications (particularly intraoperative and postoperative fractures) and a higher reoperation rate with IMN [4,10,16,29].…”

Section: Discussionmentioning

confidence: 99%

“…Historically, a sliding hip screw (SHS) has been the preferred implant to stabilize these fractures [5,13,18,21,24,25,35]. However, intramedullary hip screw devices have gained popularity for stabilizing this fracture type [2,4,7,8,10,12,16,17,29,31,32].…”

Section: Introductionmentioning

confidence: 99%

“…Many of the published studies comparing SHS and IMN for stabilization of intertrochanteric fractures have involved a small number of patients and looked at a limited number of outcomes such as mortality and need for revision surgery [2,4,7,8,10,12,16,17,29,31,32]. Our study, using a large cohort of Medicare beneficiaries, was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized with a SHS or an IMN.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

Aros¹,

Tosteson

Gottlieb

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

Aros¹,

Tosteson

Gottlieb

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…Currently, the compression hip screw (CHS), which allows impaction of the fracture, is commonest (Meislin et al 1990, Kyle et al 1994. However, the failure rate for sliding devices is unsatisfactory and ranges from 6% to 25% (Simpson et al 1989, Davis et al 1990, Bridle et al 1991, Medoff and Maes 1991, Aune et al 1994. Here, we report our experiences in a randomized series of 233 patients where a 120" fixed angle blade-plate with a buttress rod was compared to a CHS.…”

mentioning

confidence: 99%

RAB-plate vs Richards CHS plate for unstable trochanteric hip fractures: A randomized study of 233 patients with 1 -year follow-up

Buciuto¹,

Uhlin²,

Hammerby³

et al. 1998

Acta Orthopaedica Scandinavica

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“…However, many of these trials were performed by surgeons who were not experienced in the surgical technique and thus included the learning curve in the results. [13][14][15][16][17] Studies by those well experienced in the technique have given good results with a rate of failure of less than 2% for unstable trochanteric fractures and about 1% for intra-and post-operative fractures of the femoral shaft. 18 It has also been shown that intra-operative complications decline with increasing experience.…”

mentioning

confidence: 99%

The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures

Miedel

Ponzer

Törnkvist

et al. 2005

The Journal of Bone and Joint Surgery. British volume

122

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We studied 217 patients with an unstable trochanteric or subtrochanteric fracture who had been randomly allocated to treatment by either internal fixation with a standard Gamma nail (SGN) or a Medoff sliding plate (MSP, biaxial dynamisation mode). Their mean age was 84 years (65 to 99) and they were reviewed at four and 12 months after surgery. Assessments of outcome included general complications, technical failures, revision surgery, activities of daily living (ADL), hip function (Charnley score) and the health-related quality of life (HRQOL, EQ-5D).The rate of technical failure in patients with unstable trochanteric fractures was 6.5% (6/ 93) (including intra-operative femoral fractures) in the SGN group and 5.2% (5/96) in the MSP group. In patients with subtrochanteric fractures, there were no failures in the SGN group (n = 16) and two in the MSP group (n = 12). In the SGN group, there were intraoperative femoral fractures in 2.8% (3/109) and no post-operative fractures. There was a reduced need for revision surgery in the SGN group compared with the MSP group (8.3%; 9/108; p = 0.072). The SGN group also showed a lower incidence of severe general complications (p < 0.05) and a trend towards a lower incidence of wound infections (p = 0.05). There were no differences between the groups regarding the outcome of ADL, hip function or the HRQOL. The reduction in the HRQOL (EQ-5D index score) was significant in both groups compared with that before the fracture (p < 0.005).Our findings indicate that the SGN showed good results in both trochanteric and subtrochanteric fractures. The limited number of intra-operative femoral fractures did not influence the outcome or the need for revision surgery. Moreover, the SGN group had a reduced number of serious general complications and wound infections compared with the MSP group. The MSP in the biaxial dynamisation mode had a low rate of failure in trochanteric fractures but an unacceptably high rate when used in the biaxial dynamisation mode in subtrochanteric fractures.The negative influence of an unstable trochanteric or subtrochanteric fracture on the quality of life was significant regardless of the surgical method.The treatment of stable trochanteric fractures of type 1 or type 2 according to the classification of Jensen and Michaelsen (J-M) 1 is uncontroversial and good results can be expected with various implants. 2 Most authors favour the sliding hip screw (SHS) and recent studies on this method have shown rates of failure below 2%. 3,4 In the case of unstable trochanteric fractures (J-M type 3 to 5) 1 and subtrochanteric fractures, 5 the treatment is more controversial and the rate of failure for the SHS in these fractures is considerably higher, ranging from 4% to 15%. 3,4,[6][7][8][9] The Medoff sliding plate (MSP) evolved from the SHS and gives axial compression along both the femoral neck (optional) and the femoral shaft. It has produced remarkably good results in prospective trials in both unstable trochanteric and subtrochanteric fractures with a rate of fa...

show abstract

Gamma nail vs compression screw for trochanteric femoral fractures: 15 reoperations in a prospective, randomized study of 378 patients

Cited by 124 publications

References 16 publications

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

RAB-plate vs Richards CHS plate for unstable trochanteric hip fractures: A randomized study of 233 patients with 1 -year follow-up

The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures

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