The Gliding Nail, a Universal Implant in the Treatment of Proximal Femur Fractures

Abstract

Introduction: Due to the increase in the incidence of osteoporosis with age and the high biochemical load on the proximal femur, the pertrochanteric femur fracture is the typical fracture of the elderly. The number of different fracture types and the characteristic features of this patient population places high demands on any universally applicable implant. The rotational instability of the head-neck fragment in the case of a trochanter minor defect, in particular, is a significant factor in the care of pertrochanteric femur factures. The object of this study was to show that the gliding nail constitutes a universal implant for the care of proximal femur fractures with constantly maintained stability under load. Material and Methods: Between March 1996 and April 2001, 501 patients with per-and subtrochanteric fractures and an average age of 76 were included in the study. All osteosyntheses were carried out using the gliding nail which has an I-beam cross-section profile blade. 73.2% were treated operatively for closed isolated per-or subtrochanteric femur fractures. Results: All patients were restored to full weight-bearing postoperatively. The combined overall early and late complication rate following gliding nail synthesis was only 5.4%. Neither blade cut-out nor head-neck rotation was observed following gliding nail osteosynthesis. Three-month mortality rose from 2.4% in patients with no complications to 90% in patients with four complications. 92.1% of patients were independently mobile at the time of the follow-up examination. Conclusion: With its low complication rate and the ever-present possibility of full weight bearing, the gliding nail fulfills all the requirements of a modern implant for the treatment of proximal femur fractures. In our opinion, its most advantageous features are the high moment of resistance of the I-beam cross-section profile blade which ensures the possibility of gliding, the minimalized risk of proximal cut-out due to the large surface area with two planes of support in the bone, and its secure rotational stability in terms of both nail and bone. The impaction of the blade, which requires no reaming with its resulting loss of bone substance, is responsible for the excellent bone-implant interface.

Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

“… 10 11) GLN also has a rotationally stable blade profile but differs in having an H-shaped blade. 7) In biomechanical tests, GLN showed a reduction of 50% in the transmigration rate compared with GMN and 75% in comparison with the PFN double screw. 7 12) …”

“… 7) In biomechanical tests, GLN showed a reduction of 50% in the transmigration rate compared with GMN and 75% in comparison with the PFN double screw. 7 12) …”

“…Although intramedullary nailing has become popular for these reasons, some complications have been reported. Among these, two major complications-femoral shaft fractures and cut-out, 6 7) which require revision surgery-are serious.…”

Clinical and Experimental Biomechanical Studies Regarding Innovative Implants in Traumatology

“…Since 1994, extensive clinical and experimental investigations conducted in Germany have led to the development of an intramedullary gliding nail (GN). This system has the biomechanical advantages of an intramedullary locked implant, and because of the double-T angle blade profile, the gliding screw system creates an increased resistance [17] (Figure 6). The double-T profile has a higher stiffness due to its rotational stability and due to its reduced risk of damage in osteoporotic bone.…”

Accurate and Easy Measurement of Sliding Distance of Intramedullary Nail in Trochanteric Fracture

“…To reduce the risk of cut-out, various types of implants, such as hip screws and blades for trochanteric fractures, have been developed for fixating the femoral head. 8 , 9 , 10 , 11) In this report, we use the term "femoral head fixation device" (HFD) as a general term for these implants. It has been recognized that cut-out of the HFD generally occurs due to poor HFD positioning.…”