M López-Vega1, E R Gil-Monzó2, J L Rodrigo-Pérez3, J López-Valenciano4, R H Salanova-Paris2, J Peralta-Nieto2, M M Morales-Suárez5. 1. Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Doctor Peset, Valencia, España. Electronic address: lopezvega.marcos@gmail.com. 2. Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Doctor Peset, Valencia, España. 3. Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Doctor Peset, Valencia, España; Universidad de Valencia, Valencia, España. 4. Servicio de Cirugía Ortopédica y Traumatología, Hospital de Manises, Manises, Valencia, España. 5. Cátedra de Medicina Preventiva y Salud Pública, Universidad de Valencia, Valencia, España.
Abstract
OBJECTIVE: The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. MATERIAL AND METHODS: Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. RESULTS: The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p < 0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p < 0.05), but this significance disappears when adjusting for other patient-related characteristics. CONCLUSIONS: Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use.
RCT Entities:
OBJECTIVE: The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. MATERIAL AND METHODS: Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. RESULTS: The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p < 0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p < 0.05), but this significance disappears when adjusting for other patient-related characteristics. CONCLUSIONS: Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use.
Authors: Rafael Luque Pérez; Pablo Checa Betegón; María Galán-Olleros; Camila Arvinius; Jose Valle-Cruz; Fernando Marco Journal: Arch Orthop Trauma Surg Date: 2020-11-04 Impact factor: 3.067
Authors: Sharon R Lewis; Richard Macey; Joseph Lewis; Jamie Stokes; James R Gill; Jonathan A Cook; William Gp Eardley; Martyn J Parker; Xavier L Griffin Journal: Cochrane Database Syst Rev Date: 2022-02-10