Abstract
Purpose
The aim of this study was to compare two intramedullary devices used in the treatment of intertrochanteric fractures.
Method
During the period 2006–2007 46 TGN and 51 PFNA were used for the treatment of intertrochanteric fractures in our hospital. Clinical and radiological follow-up were available. Surgical time, blood loss and complications have been considered.
Results
The mean operative time for the TGN group was significantly higher than in the PFNA group (62 min and 45 min, respectively) with a p = 0.04. The mean blood loss was significantly higher in the TGN group (285 ml; SD 145) in relation to the PFNA group (226 ml; SD 136) with p = 0.03. Also, rate of complications was higher in the TGN group (p = 0.01). Clinical outcomes were good for both groups. Intra-operative and post-operative complications in the TGN group were associated with a longer operative time and a higher blood loss, probably due to the reaming needed in TGN that can increase blood loss and risk of comminution or fracture propagation. Moreover, all but one of the procedure-related complications were observed in very elderly patients.
Conclusions
Based on our results in the intertrochanteric fracture, use of PFNA should be recommended in cases of elderly and osteoporotic patients, while TGN should be used in more severely displaced fractures in patients with a slightly better bone mineral density.
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References
Anglen JO, Weinstein JN (2008) Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg 90:700–707
Leung KS, So WS, Shen WY (1992) Gamma nails and dynamic hip screw for peritrochanteric fractures a randomized prospective study in elderly patients. J Bone Joint Surg 74:345–351
Sadowski C, Lubbeke A, Saudan M (2002) Treatment of revers oblique and transverse intertrochanteric fractures with use of intramedullary nail or 95° screw plate. J Bone Joint Surg 84:372–381
Hardy DCR, Descamps P, Krallis P, Fabeck L, Smets P, Bertens CL, Delince FE (1998) Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg 80:618–630
Parker MJ, Handoll HH (2005) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 19(4):CD000093
Pelet S, Arlettaz Y, Chevalley F (2001) Ostheosyntesis of per-and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study. Swiss Surg 7(3):126–133
Moroni A, Faldini C, Pegreffi F (2005) Dynamic hip screw compared with external fixation for treatment of osteoporotic pertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg 87:753–759
Müller M, Seitz A, Besch L, Hilgert RE, Seekamp A (2008) Proximal femur fractures: results and complications after osteosynthesis with PFN and TGN. Unfallchirurg 111(2):71–77
Megas P, Kaisidis A, Zouboulis P, Papas M, Panagopoulos A, Lambiris E (2005) Comparative study of the treatment of pertrochanteric fractures- trochanteric gamma nail vs proximal femoral nail. Z Orthop Grenzgeb 143(2):252–257
D’Arrigo C, Perugia D, Carcangiu A, Monaco E, Speranza A, Ferretti A (2010) Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop 34(7):939–942
Karunakar AM, McLaurin TM, Morgan JS, Egol KA. (2009) How to improve outcomes after perthrocanteric fracture. Instructional course lecture handout. 2009 AAOS Annual Meeting, Las Vegas, NV
Pervez H, Parker MJ, Pryor GA, Lutchman L, Chirodian N (2002) Classification of trochanteric fracture of the proximal femur: a study of the reliability of current systems. Injury 33(8):713
Rosencher N, Kerkkamp HE, Macheras G (2003) Orthopedic surgery transfusion haemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 43:459–469
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755
Brunner A, Jöckel JA, Babst R (2008) The PFNA proximal femur nail in treatment of unstable proximal femur fractures—3 cases of postoperative perforation of the helical blade into the hip joint. J Othop Trauma 22:731–736
Herrera A, Domingo LJ, Calvo A, Martìnez A, Cuenca JA (2002) Comparative study of trochanteric fractures treated with the gamma nail or the proximal femoral nail. Int Orthop 26:365–369
Schipper IB, Steyerberg EW, Castelein RM, Van Der Heijden FHWM, Den Hoed PT, Kerver AJH, Van Vugt AB (2004) Treatment of unstable trochanteric fractures—randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br 86B:86–94
Perez JV, Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femoral fracture-an autopsy study. Injury 26:237–240
Docquier PL, Manche E, Autrique JC, Geulette B (2002) Complications associated with gamma nailing. A review of 439 cases. Acta Orthop Belg 68(3):251–257
Kouvidis GK, Sommers MB, Giannoudis PV, Katonis PG, Bottlang M (2009) Comparison of migration behavior between single and dual lag screw implants for intertrochanteric fracture fixation. J Orthop Surg Res 18:4–16
Al-Munajjed AA, Hammer J, Mayr E, Nerlich M, Lenich A (2008) Biomechanical characterisation of osteosyntheses for proximal femur fractures: helical blade versus screw. Stud Health Technol Inform 133:1–10
Schipper IB, Steyerberg EW, Castelein RM et al (2004) Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral. J Bone Joint Surg Br 86(1):86–94
Hwang JH, Oh JK, Han SH, Shon WY, Oh CV (2008) Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fracture. Arch Orthop Trauma Surg 128(12):1443–1446
Nikolaou VS, Papathanasopoulos A, Giannoudis PV (2008) What’s new in the management of proximal femoral fractures? Injury 39(12):1309–1318
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D’Arrigo, C., Carcangiu, A., Perugia, D. et al. Intertrochanteric fractures: comparison between two different locking nails. International Orthopaedics (SICOT) 36, 2545–2551 (2012). https://doi.org/10.1007/s00264-012-1684-5
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DOI: https://doi.org/10.1007/s00264-012-1684-5