Use of the gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life

Abstract

BackgroundTrochanteric fractures are common fractures in the elderly. Due to characteristic demographic changes, the incidence of these injuries is rapidly increasing. Treatment of these fractures is associated with high rates of complications. In addition, the long-term results remain poor, with high morbidity, declines in function, and high mortality. Therefore, in this study, complication rates and patients’ outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3™ nail.MethodsPatients aged 60 years old or older, with pertrochanteric and subtrochanteric femoral fractures, were included. Patients with polytrauma or pathological fractures were excluded. Age, sex, and fracture type were collected on admission. In addition, data were recorded concerning the surgeon (resident vs. consultant), time of operation, and local or systemic perioperative complications. Complications were also collected at the 6- and 12-month follow-ups after trauma. Barthel Index, IADL, and EQ-5D measurements were evaluated retrospectively on admission, as well as at discharge and during the follow-up.ResultsNinety patients were prospectively included between April 2009 and September 2010. The patients’ average age was 81 years old, and their average ASA score was 3. The incision/suture time was 53 min (95% CI 46–60 min). Hospital mortality was 4%, and overall mortality was 22% at the 12-month follow-up. Eight local complications occurred (4 haematomas, 1 deep infection, 1 cutting out, 1 irritation of the iliotibial tract, 1 periosteosynthetic fracture). The incidence of relevant systemic complications was 6%. Forty-two percent of the patients were operated on by residents in training, without significant differences in duration of surgery, complication rate, or mortality rate. The Barthel Index (82 to 71, p < .001), IADL (4.5 to 4.3, p = .0195) and EQ-5-D (0.75 to 0.66, p = .068) values did not reach pre-fracture levels during the follow-up period of 12 months.ConclusionThe results showed a relatively low complication rate using the Gamma3™ nail, even if the nailing was performed by residents in training. The high mortality, declines in function, and low quality of life could probably be attributed to pre-existing conditions, such as physical status.In summary, the Gamma3™ nail seems to be a useful implant for the nailing of trochanteric fractures, although further studies are necessary comparing different currently available devices.

Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

“…The treatment of these fractures must be aimed to early assisted walking restoration, to reduction of hospitalization time and of morbidity of the patient. Factors associated with a better outcome are an early treatment, an anatomical reduction of fragments, a stable osteosynthesis, an early mobilization, and a full weight bearing and walking [21,22]. Following these principles, we carried out a randomized prospective study and we compared functional and radiological outcomes and complication rate in patients treated with two different proximal femoral nail for a pertrochanteric fracture.…”

Complications in Treatment of 31-A Fractures with Trochanteric Gamma Nail (TGN) Versus Gamma3 Nail (G3N) - A Review of 217 Cases

“…These new nails have a proximal diameter of 15.5mm compared to the previous 17mm. The idea was to help shorten the incision length for minimally invasive surgery, while offering the biomechanical strength and cut-out resistance of the established Trochanteric and Long Gamma Nails [13]. …”

Lebensqualität und Arbeitsfähigkeit nach operativer Behandlung von Tibiakopffrakturen

“…Grundsätz-lich ist die Lebensqualität nach operativer Frakturversorgung an Extremitäten und Stamm zu Anfang deutlich herabgesetzt [13,20,24,26,40,50], Tibiakopf-und Tibiaschaftfrakturen eingeschlossen [4,21,39]. Innerhalb von 2 Jahren kommt es zu einer Verbesserung [7,8,13,16,28,40], wobei jedoch Einschränkungen bei 58% der Patienten verbleiben [35] und auch noch 4 Jahre nach Frakturversorgung nachzuweisen sind [18]. Die genannten Studien verwendeten als Messinstrument der Lebensqualität entweder den SF-36 [9] oder den EQ-5D ("Euro Quality of life 5D").…”