Clinical effects of locking gamma nail versus modified gamma nail for treatment of unstable intertrochanteric femoral fractures in elderly patients

doi:10.3877/cma.j.issn.1674-0785.2017.16.002

Abstract

Abstract:

Objective

To compare the clinical effects of locking gamma nail (LGN) with modified gamma nail (MGN) in the management of unstable intertrochanteric femoral fractures in elderly patients.

Methods

A total of 143 elderly patients with unstable intertrochanteric femoral fractures who were treated with LGN (n = 67) or MGN (n = 76) at the 118th Hospital of PLA from January 2008 to May 2012 and had complete clinical data were retrospectively studied. We compare the two groups in terms of fracture healing time, Harris hip score, degree of fracture compression, and variation of Neck shaft angle. Continuous variables (fracture healing time, Harris hip score, and the degree of fracture compression) were compared using the paired t-test, and comparison of categorical variables (the change of Neck shaft angle) was performed using the chi-squared test.

Results

All of the patients were followed successfully. Compared with the MGN group, the LGN group had significantly longer fracture healing time [(16.8 ± 7.4) weeks vs (14.4 ± 6.6) weeks], less variation of neck-shaft angle (3.0% vs 14.5%), lower degree of fracture compression [(4.4 ± 2.5) mm vs (7.3 ± 3.1) mm], and higher Harris hip score [(86.6 ± 6.3) scores vs (83.1 ± 6.7) scores] (P < 0.05 for all).

Conclusion

Both LGN and MGN are effective in the management of unstable intertrochanteric femoral fractures in elderly patients, but LGN has more advantages in preventing compression of fracture end and recovery of hip joint function compared to MGN.

Key words: Intertrochanteric femoral fractures, Unstable, Elderly patients, Locking gamma nail, Internal fixation

Lei Zhang, Jie Shen, Zaiyu Huang, Dan Liu, Shuai He, Zhihao Ying, Zhendong Wu. Clinical effects of locking gamma nail versus modified gamma nail for treatment of unstable intertrochanteric femoral fractures in elderly patients[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(16): 2115-2119.

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References 17

[1]	Carpintero P, Caeiro JR, Carpintero R, et al. Complications of hip fractures: A review [J]. World J Orthop, 2014, 5(4): 402-411.
[2]	Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults [J]. Cochrane Database Syst Rev, 2010, 8(9): CD000093.
[3]	张磊, 刘丹, 吴震东, 等. 锁定型GAMMA钉治疗不稳定性股骨粗隆间骨折的生物力学分析 [J]. 中国矫形外科杂志, 2010, 18(12): 1028-1029.
[4]	Zhang L, Shen J, Chen SX, et al. Treatment of unstable intertrochanteric femoral fractures with locking gamma nail(LGN): A retrospective cohort study [J]. Int J Surg, 2016, 26(5): 12-17.
[5]	Magi E. ASA classification and perioperative variables as predictors of postoperative outcome [J]. Br J Anaesth, 1997, 78(2): 228.
[6]	Reuling EM, Sierevelt IN, van den Bekerom MP, et al. Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score [J]. Arch Orthop Trauma Surg, 2012, 132(2): 249-256.
[7]	Hassankhani EG, Omidi-Kashani F, Hajitaghi H, et al. How to treat the complex unstable intertrochanteric fractures in elderly patients? DHS or arthroplasty [J]. Arch Bone Joint Surg, 2014, 2(3): 174.
[8]	Kleweno C, Morgan J, Redshaw J, et al. Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years [J]. J Orthop Trauma, 2014, 28(7): 391-397.
[9]	Gotfried Y. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation [J]. J Bone Joint Surg Am, 2007, 89(11): 2552-2553.
[10]	Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies [J]. J Bone Joint Surg Am, 2004, 86(2): 398-410.
[11]	Saarenpaa I, Heikkinen T, Ristiniemi J, et al. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients [J]. Int Orthop, 2009, 33(1): 255-260.
[12]	Bojan AJ, Beimel C, Taglang G, et al. Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures [J]. BMC Musculoskel Dis, 2013, 14(1): 1.
[13]	Vidyadhara S, Rao SK. Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur-One or two femoral neck screws? [J]. Injury, 2009, 40(3): 296-303.
[14]	Ma J, Xing D, Ma X, et al. The percutaneous compression plate versus the dynamic hip screw for treatment of intertrochanteric hip fractures: a systematic review and meta-analysis of comparative studies [J]. Orthop Traumatol Surg Res, 2012, 98(7): 773-783.
[15]	Kuzyk PR, Shah S, Zdero R, et al. A biomechanical comparison of static versus dynamic lag screw modes for cephalomedullary nails used to fix unstable peritrochanteric fractures [J]. J Trauma Acute Care Surg, 2012, 72(2): E65-E70.
[16]	Dujardin F, Benez C, Polle G, et al. Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area: preliminary results [J]. J Orthopaed Trauma, 2001, 15(6): 401-406.
[17]	Zhu Y, Meili S, Zhang C, et al. Is the lag screw sliding effective in the intramedullary nailing in A1 and A2 AO-OTA intertrochanteric fractures? A prospective study of Sliding and None-sliding lag screw in Gamma-Ⅲ nail [J]. Scand J Trauma Resusc Emerg Med, 2012, 20(1): 1-8.

组别	例数	年龄（岁，±s）	性别		AO分型		术前ASA分级				骨折复位质量
组别	例数	年龄（岁，±s）	男	女	A2	A3	Ⅰ	Ⅱ	Ⅲ	Ⅳ	良好	可	差
LGN组	67	80.5±7.3	27	40	50	17	13	38	16	0	58	7	2
MGN组	76	80.0±6.9	30	46	57	19	15	42	19	0	65	8	3
统计值	?	t=0.402	χ²=0.010		χ²=0.003		χ²=0.034				χ²=0.099
P值	?	0.689	0.920		0.959		0.983				0.952

组别	例数	年龄（岁，±s）	性别		AO分型		术前ASA分级				骨折复位质量
组别	例数	年龄（岁，±s）	男	女	A2	A3	Ⅰ	Ⅱ	Ⅲ	Ⅳ	良好	可	差
LGN组	67	80.5±7.3	27	40	50	17	13	38	16	0	58	7	2
MGN组	76	80.0±6.9	30	46	57	19	15	42	19	0	65	8	3
统计值	?	t=0.402	χ²=0.010		χ²=0.003		χ²=0.034				χ²=0.099
P值	?	0.689	0.920		0.959		0.983				0.952

组别	例数	随访时间（个月）	骨折愈合（周）	末次Harris评分（分）	颈干角改变≥10^°[例（%）]	骨折压缩（mm）
LGN组	67	23.0±6.4	16.8±7.4	86.6±6.3	2（3.0）	4.4±2.5
MGN组	76	23.2±5.8	14.4±6.6	83.1±6.7	11（14.5）	7.3±3.1
统计值	?	t=-0.299	t=2.046	t=3.253	χ²=4.382	t=-6.161
P值	?	0.766	0.043	0.001	0.036	0.000

组别	例数	随访时间（个月）	骨折愈合（周）	末次Harris评分（分）	颈干角改变≥10^°[例（%）]	骨折压缩（mm）
LGN组	67	23.0±6.4	16.8±7.4	86.6±6.3	2（3.0）	4.4±2.5
MGN组	76	23.2±5.8	14.4±6.6	83.1±6.7	11（14.5）	7.3±3.1
统计值	?	t=-0.299	t=2.046	t=3.253	χ²=4.382	t=-6.161
P值	?	0.766	0.043	0.001	0.036	0.000

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