Felix Bonnaire1, Thomas Lein2,3, Tim Fülling2, Philipp Bula2,4. 1. Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany. felix.bonnaire@klinikum-dresden.de. 2. Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany. 3. Diakonissenkrankenhaus Dresden, Holzhofgasse 29, 01099, Dresden, Germany. 4. Klinikum Gütersloh, Reckenberger Str. 19, 33332, Dresden, Germany.
Abstract
INTRODUCTION: Third-generation nails for the management of unstable trochanteric fractures were evaluated with regard to outcomes. PATIENTS AND METHODS: A prospective observational study comparing the Gamma 3 nail and the Proximal Femoral Nail Antirotation (PFNA) in 106 unstable trochanteric fractures confirms the recently reported low intra- and postoperative complication rates from retrospective cohort studies. RESULTS: Studies of same generations of both intramedullary nail systems did not reveal significant differences in intra- or postoperative complications. Intraoperative dislocation during nail insertion occurred 7 times for the Gamma nail and 9 times for the PFNA. The standard PFNA had to be exchanged intraoperatively for a shorter one on two occasions. Superficial wound healing disorders and hematoma requiring revision were observed in four patients in the Gamma 3 nail group and in three patients in the PFNA group. No deep infections were documented. Mechanical complications required revision in four patients (7.5%) after Gamma nailing and in two patients (3.8%) after PFNA. Postoperative rotation of the head-neck fragment was observed for the Gamma nail in three patients, not in the PFNA group. This was not statistically significant (p = 0.08). There were neither incidences of cut out without renewed trauma nor intraoperative fracture or postoperative femoral fracture. Nonunion affected 1 of 18 patients in late follow-up (p = 0.3) in the Gamma 3 nail group. DISCUSSION: The Gamma 3 nail and the PFNA yielded comparable clinical results and significantly improved outcomes for unstable trochanteric fractures compared to older nail generations.
INTRODUCTION: Third-generation nails for the management of unstable trochanteric fractures were evaluated with regard to outcomes. PATIENTS AND METHODS: A prospective observational study comparing the Gamma 3 nail and the Proximal Femoral Nail Antirotation (PFNA) in 106 unstable trochanteric fractures confirms the recently reported low intra- and postoperative complication rates from retrospective cohort studies. RESULTS: Studies of same generations of both intramedullary nail systems did not reveal significant differences in intra- or postoperative complications. Intraoperative dislocation during nail insertion occurred 7 times for the Gamma nail and 9 times for the PFNA. The standard PFNA had to be exchanged intraoperatively for a shorter one on two occasions. Superficial wound healing disorders and hematoma requiring revision were observed in four patients in the Gamma 3 nail group and in three patients in the PFNA group. No deep infections were documented. Mechanical complications required revision in four patients (7.5%) after Gamma nailing and in two patients (3.8%) after PFNA. Postoperative rotation of the head-neck fragment was observed for the Gamma nail in three patients, not in the PFNA group. This was not statistically significant (p = 0.08). There were neither incidences of cut out without renewed trauma nor intraoperative fracture or postoperative femoral fracture. Nonunion affected 1 of 18 patients in late follow-up (p = 0.3) in the Gamma 3 nail group. DISCUSSION: The Gamma 3 nail and the PFNA yielded comparable clinical results and significantly improved outcomes for unstable trochanteric fractures compared to older nail generations.