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Comparison between locked and unlocked intramedullary nails in intertrochanteric fractures

European Journal of Orthopaedic Surgery & Traumatology volume 28, pages 649–658 (2018)Cite this article

Abstract

Background

Intertrochanteric fractures are of great interest worldwide and are the most frequently operated fractures. Intramedullary nailing is commonly used in the treatment of intertrochanteric fractures. The purpose of this study is to assess the necessity of using the distal blocking screw in 31-A1 and 31-A2 fractures, classified according to the Orthopaedic Trauma Association classification system (AO/OTA).

Methods

This is a prospective study of 143 consecutive patients (mean age 85.01 years, mean final follow-up 14.1 months) surgically treated with the same intramedullary nail. In 75 cases, the distal locking screw was not used. Parameters evaluated during follow-up were: blood loss, transfusion requirements, surgery duration, and fluoroscopy time. Harris Hip Score and Barthel Activity Daily Living were used for the clinical evaluation. Radiographic Union Score For Hip (RUSH score) and Tip apex distance (TAD) were measured for radiologic evaluation.

Results

The group treated without locking screw showed significantly shorter surgical duration time (31.9 vs. 47.2 min), a decrease in blood loss (variation Hb − 1.06 vs. − 1.97), and reduced X-rays exposure time (25.4 vs. 31.6 s). No significant differences were observed in the postoperative period and in the radiographic and clinical scores.

Conclusion

This study demonstrates that in intertrochanteric 31-A1 and 31-A2 stable fractures, the absence of distal locking screw does not compromise bone healing and prevents several clinical complications.

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References

  1. Angulo Tabernero M, Aguilar Ezquerra A, Ungria Murillo J, Cuenca Espierrez J (2015) Epidemiology of fractures of the proximal third of the femur: 20 years follow-up. Rev Fac Cien Med Univ Nac Cordoba 72(3):145–151

    PubMed  Google Scholar 

  2. Icks A, Arend W, Becker C et al (2013) Incidence of hip fractures in Germany, 1995–2010. Arch Osteoporos 8:140. https://doi.org/10.1007/s11657-013-0140-5

    Article  PubMed  Google Scholar 

  3. Pedersen AB, Baggesen LM, Ehrenstein V, Pedersen L, Lasgaard M, Mikkelsen EM (2016) Perceived stress and risk of any osteoporotic fracture. Osteoporos Int 27(6):2035–2045. https://doi.org/10.1007/s00198-016-3490-1

    CAS  Article  PubMed  Google Scholar 

  4. Dujardin FH, Benez C, Polle G, Alain J, Biga N, Thomine JM (2001) Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area: preliminary results. J Orthop Trauma 15(6):401–406

    CAS  Article  PubMed  Google Scholar 

  5. Hesse B, Gächter A (2004) Complications following the treatment of trochanteric fractures with the gamma nail. Arch Orthop Trauma Surg 124(10):692–698

    Article  PubMed  Google Scholar 

  6. Pajarinen J, Lindahl J, Michelsson O et al (2005) Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br 87(1):76–81

    CAS  Article  PubMed  Google Scholar 

  7. Haidukewych GJ (2009) Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg Am 91(3):712–719

    PubMed  Google Scholar 

  8. Gallagher D, Adams B, El-Gendi H et al (2013) Is distal locking necessary? A biomechanical investigation of intramedullary nailing constructs for intertrochanteric fractures. J Orthop Trauma 27(7):373–378. https://doi.org/10.1097/BOT.0b013e31827cd5bd

    Article  PubMed  Google Scholar 

  9. Rosenblum SF, Zuckerman JD, Kummer FJ et al (1992) A biomechanical evaluation of the Gamma nail. J Bone Joint Surg Br 74(3):352–357

    CAS  Article  PubMed  Google Scholar 

  10. Bhandari M, Chiavaras MM, Parasu N et al (2013) Radiographic union score for hip substantially improves agreement between surgeons and radiologists. BMC Musculoskelet Disord 14:70. https://doi.org/10.1186/1471-2474-14-70

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chiavaras MM, Bains S, Choudur H et al (2013) The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons. Skelet Radiol 42(8):1079–1088. https://doi.org/10.1007/s00256-013-1605-8

    Article  Google Scholar 

  12. Court-Brown CM, Heckman JD, McQueen M, Ricci W, Tornetta P III, McKee M (2014) Rockwood and Green’s fractures in adults, VIII edn. Wolters Kluwer, Riverwoods

  13. Ma J, Xing D, Ma X et al (2012) The percutaneous compression plate versus the dynamic hip screw for treatment of intertrochanteric hip fractures: a systematic review and meta-analysis of comparative studies. Orthop Traumatol Surg Res 98(7):773–783. https://doi.org/10.1016/j.otsr.2012.07.004

    CAS  Article  PubMed  Google Scholar 

  14. Varela-Egocheaga JR, Iglesias-Colao R, Suárez-Suárez MA et al (2009) Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail. Arch Orthop Trauma Surg 129(10):1401–1407. https://doi.org/10.1007/s00402-009-0955-0

    Article  PubMed  Google Scholar 

  15. Robinson CM, Adams CI, Craig M et al (2002) Implant-related fractures of the femur following hip fracture surgery. J Bone Joint Surg Am 84-A(7):1116–1122

    CAS  Article  PubMed  Google Scholar 

  16. López-Vega M, Gil-Monzó ER, Rodrigo-Pérez JL et al (2015) Randomized prospective study on the influence distal block and Gamma 3 nail on the treatment of intertrochanteric fractures of femur. Rev Esp Cir Ortop Traumatol 59(1):26–35. https://doi.org/10.1016/j.recot.2014.06.004

    PubMed  Google Scholar 

  17. Ozkan K, Unay K, Demircay C, Cakir M, Eceviz E (2009) Distal unlocked proximal femoral intramedullary nailing for intertrochanteric femur fractures. Int Orthop 33(5):1397–1400. https://doi.org/10.1007/s00264-008-0673-1

    Article  PubMed  Google Scholar 

  18. Karn NK, Singh GK, Kumar P, Singh MP, Shrestha BP, Chaudhary P (2009) Management of trochanteric fractures of the femur with external fixation in high-risk patients. Int Orthop 33(3):785–788. https://doi.org/10.1007/s00264-008-0546-7

    Article  PubMed  Google Scholar 

  19. Barry TP (1984) Radiation exposure to an orthopedic surgeon. Clin Orthop Relat Res 182:160–164

    Google Scholar 

  20. Hardy DC, Drossos K (2003) Slotted intramedullary hip screw nails reduce proximal mechanical unloading. Clin Orthop Relat Res 406:176–184

    Article  Google Scholar 

  21. Huang H, Xin J, Ma B (2014) Analysis of complications of intertrochanteric fracture treated with Gamma 3 intramedullary nail. Int J Clin Exp Med 7(10):3687–3693

    PubMed  PubMed Central  Google Scholar 

  22. Macario A (2010) What does one minute of operating room time cost? J Clin Anesth 22(4):233–236. https://doi.org/10.1016/j.jclinane.2010.02.003

    Article  PubMed  Google Scholar 

  23. Albareda J, Laderiga A, Palanca D, Paniagua L, Seral F (1996) Complications and technical problems with the gamma nail. Int Orthop 20(1):47–50

    CAS  Article  PubMed  Google Scholar 

  24. Saarenpää I, Heikkinen T, Jalovaara P (2007) Treatment of subtrochanteric fractures. A comparison of the Gamma nail and the dynamic hip screw: short-term outcome in 58 patients. Int Orthop 31(1):65–70

    Article  PubMed  Google Scholar 

  25. Han CD, Lee YH, Yang KH et al (2013) Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography. Arch Orthop Trauma Surg 133(3):361–366. https://doi.org/10.1007/s00402-012-1674-5

    Article  PubMed  Google Scholar 

  26. Davis BJ, Roberts PJ, Moorcroft CI, Brown MF, Thomas PBM, Wade RH (2004) Reliability of radiographs in defining union of internally fixed fractures. Injury 235(6):557–561

    Article  Google Scholar 

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Affiliations

  1. U.O.C. Orthopedics and Traumatology Department, SM Misericordia Hospital, University of Perugia, Perugia, Italy

    Riccardo Maria Lanzetti, Auro Caraffa, Paolo Ceccarini, Francesco Manfreda, Cristina Ibáñez Vicente, Giuseppe Rinonapoli & Michele Bisaccia

  2. Radio-Diagnostic Department, SM Misericordia Hospital, University of Perugia, Perugia, Italy

    Giulio Gambaracci, Daniele Maiettini & Michele Scialpi

  3. U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

    Luigi Meccariello

  4. Radiology Unit, Department of Diagnostic Imaging, “Niguarda Ca’ Granda” Hospital, Milan, Italy

    Olga Bisaccia

  5. University of Rome, La Sapienza, Rome, Italy

    Domenico Lupariello

Authors
  1. Riccardo Maria Lanzetti
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  2. Auro Caraffa
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  3. Domenico Lupariello
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  4. Paolo Ceccarini
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  7. Francesco Manfreda
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  9. Cristina Ibáñez Vicente
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Correspondence to Riccardo Maria Lanzetti.

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Cite this article

Lanzetti, R.M., Caraffa, A., Lupariello, D. et al. Comparison between locked and unlocked intramedullary nails in intertrochanteric fractures. Eur J Orthop Surg Traumatol 28, 649–658 (2018). https://doi.org/10.1007/s00590-018-2143-9

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  • DOI: https://doi.org/10.1007/s00590-018-2143-9

Keywords

  • Intertrochanteric Fractures
  • Intramedullary Nailing
  • Radiographic Union Score
  • Compromised Bone Health
  • Cephalic Screw