Breakage of a Third Generation Gamma Nail: A Case Report and Review of the Literature

The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant.

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Short term results of modular bipolar hemiarthroplasty for the treatment of neglected trochanteric femur fracture in the elderly

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195620 ◽

2019 ◽

Vol 6 (1) ◽

pp. 53

Author(s):

Towseef Ahmad Bhat ◽

Zameer Ali ◽

Manik Sehgal

Keyword(s):

Femoral Fractures ◽

The Elderly ◽

Clinical Results ◽

Good Choice ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Postoperative Rehabilitation ◽

Cemented Bipolar Hemiarthroplasty ◽

Fractures Of The Femur

Background: In rural India because of native practitioner culture people tend to neglect orthopaedic injuries and often present late to the hospitals. Bipolar hemiarthroplasty for neglected intertrochanteric fractures of the femur in the elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.Methods: Sixteen patients with proximal extracapsular femoral fractures presented average 10.4 weeks late from the day of injury, were treated with modular bipolar hemiarthroplasty. There were 11 men and 5 women, with mean age of 72.8 years (range: 65–83 years). Primary cemented bipolar hemiarthroplasty was performed using the Hardinge lateral approach in a lateral decubitus position. Harris hip score was used for the clinical evaluation of the patients.Results: Clinically, the Harris hip score at the last follow-up ranged from 92 to 59, with a mean value of 81.7. Postoperative radiographs showed a good position in all patients. 1 patient developed complication during cementing and 1 case came with dislocation. No case of infection, acetabular erosion, periprostheic fracture or implant loosening was reported in this study.Conclusions: Primary cemented bipolar hemiarthroplasty is a good choice in elderly patients with neglected intertrochanteric fractures of the femur.

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Interest of Surgical Treatment of Per-Trochanteric Fractures by Gamma Nail: About 100 Cases

Galician Medical Journal ◽

10.21802/gmj.2018.4.4 ◽

2018 ◽

Vol 25 (4) ◽

Author(s):

Omar Mourafiq ◽

Youssef Benyias ◽

Hicham Benomar ◽

Valery Kamenan ◽

Jalal Boukhriss ◽

...

Keyword(s):

Trochanteric Fracture ◽

Functional Results ◽

The Elderly ◽

Gamma Nail ◽

Infectious Complications ◽

Trochanteric Fractures ◽

Male Predominance ◽

Trochanteric Region ◽

The Military ◽

Consolidation Time

Gamma nail closed osteosynthesis has surpassed several methods previously used in the treatment of fractures in the trochanteric region. The objective of the research was to carry out an epidemiological study and to assess the evolutionary profile of patients with per-trochanteric fracture treated with gamma nail. Materials and methods. In this retrospective study, we report the experience of the Traumatology-Orthopedics Service II of the Military Teaching Hospital Mohamed V-Rabat, in the treatment of per-trochanteric fractures by gamma nail in 100 cases, collected between January 2011 and March 2016. Results. The average age of our patients was 68 years, with a male predominance of 67%. The most reported etiology (92% of cases) was simple drop. Stable fractures were the most common (81%), with a predominance of simple per-trochanteric fractures. The average response time was 24 hours, the average duration of the surgical procedure was 45 minutes. The rate of infectious complications was 1%; the rate of mechanical complications was 1%. The functional results were excellent and good in 95% of cases. The average consolidation time was 8 weeks. Conclusions. Trochanteric fracture is a delayed emergency which is seen primarily in the elderly. The gamma nail represents one of the latest improvements in implants for the treatment of these fractures. We report a series of 100 cases of trochanteric fractures treated surgically by gamma nail. The functional results were very encouraging compared to those reported in the literature.

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Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail

Injury ◽

10.1016/j.injury.2010.03.005 ◽

2010 ◽

Vol 41 (12) ◽

pp. 1234-1238 ◽

Cited By ~ 62

Author(s):

Xu Yaozeng ◽

Geng Dechun ◽

Yang Huilin ◽

Zhu Guangming ◽

Wang Xianbin

Keyword(s):

Comparative Study ◽

Trochanteric Fracture ◽

Gamma Nail ◽

Proximal Femoral Nail ◽

Third Generation ◽

The Third ◽

Femoral Nail

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Comparative Study of the Second and Third Generation of Gamma Nail for Trochanteric Fractures

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000000190 ◽

2015 ◽

Vol 29 (3) ◽

pp. e85-e90 ◽

Cited By ~ 11

Author(s):

Juan Mingo-Robinet ◽

Miguel Torres-Torres ◽

Carmen Martínez-Cervell ◽

Juan Antonio Alonso del Olmo ◽

Jose A. Rivas Laso ◽

...

Keyword(s):

Comparative Study ◽

Gamma Nail ◽

Third Generation ◽

Trochanteric Fractures

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A STUDY TO DETERMINE THE FUNCTIONAL OUTCOME IN THE MANAGEMENT OF STABLE PER TROCHANTERIC HIP FRACTURES WITH DYNAMIC HIP SCREW.

10.36106/ijar/4202586 ◽

2021 ◽

pp. 70-73

Author(s):

amit Supe ◽

Jayesh Anant Mhatre ◽

Nihar Modi ◽

Kartik Pande ◽

Eknath Pawar

Keyword(s):

Tertiary Care ◽

The Elderly ◽

Dynamic Hip Screw ◽

Biomechanical Property ◽

Care Hospital ◽

Trochanteric Fractures ◽

Early Ambulation ◽

Intertrochanteric Hip Fracture ◽

Hip Screw ◽

Fractures Of The Femur

BACKGROUND: The use of a dynamic hip screw (DHS) for stable as well as unstable intertrochanteric hip fracture xation has been successfully applied in fracture healing for more than 25years. DHS xation on unstable trochanteric fractures still has a more failure rate compared to stable fractures, mostly due to osteoporosis in patients. Thus, this study is aimed to investigate the biomechanical property of the DHS system to provide the stable xation in intertrochanteric A1 and A2 fractures1. MATERIAL AND METHODS: This is a retrospective study of 54 patients with trochanteric fractures of the femur that were treated with DHS (Dynamic hip screw) during the period of two years from April 2019 to March 2021 in a tertiary care hospital. All surgeries were performed under spinal and epidural anaesthesia. Surgery done was an internal xation with DHS plate. Results: Among 54 cases, 55.5% were A1, and 44.4% were A2 pertrochanter fractures. The clinical and functional outcomes of the procedure were excellent in 25 patients (46.29%), good in 19 patients (35.18%), fair in 8 patients (14.81%), and 2 (3.7%) of the patients had poor results. CONCLUSIONS: Intertrochanteric fractures are essentially fractures of the elderly, which demand prompt treatment and early ambulation. The dynamic hip screw is the operative treatment of choice for stable trochanteric fractures

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INTRAMEDULLARY PROXIMAL FEMORAL NAILING FOR UNSTABLE PERITROCHANTRIC FRACTURE: A PROSPECTIVE STUDY

10.36106/7323693 ◽

2021 ◽

pp. 79-82

Author(s):

Arun Kumar C ◽

Rakesh Kumar B ◽

Vaibhav Chaurasia ◽

Venkatachalam K ◽

Sathish Babu ◽

...

Keyword(s):

Prospective Study ◽

Wound Infection ◽

Trochanteric Fracture ◽

Operation Time ◽

Fracture Site ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Trochanteric Fractures ◽

A Prospective Study

Trochanteric fracture id one of the commonest fractures in Orthopaedics and also among the most devastating injuries of the elderly. The incidence of this fracture increases with advancing age. Around 50% of the Peri-trochanteric variant of these fractures, are of the unstable type. PFNA2 deploys a helical blade which provides compressibility and an additional rotation control at the fracture site.The aim of this study is to assess the effectiveness of Intra-medullary xation of unstable peri-trochanteric fractures with inter-locking proximal femoral nail PFNA2, in a prospective study. This study was done in Department of Orthopaedics, Chettinad Hospital and Research institute, Kelambakkam, Chengalpattu district, Tamilnadu and was spread over 4 years from Jan 2017 to December 2020 with minimum follow-up period of 12 months. 66 patients participated in this study. Harris Hip Score was used to assess the functional outcome. The Harris Hip Score, mean at 6 months was 75.35, which improved to 82.02 by 12 months of follow-up. With regard to our complications 4 patients had a superior cut out of helical screw, which required re-operation by bipolar hemiarthroplasty of the cemented variant. 9 patients had a varus deformity of 10-12 degrees. Abductor lurch was noted in 11 patients. Supercial-wound infection occurred in 8 patients and deep wound infection, requiring surgical irrigation occurred in 3 patients. In conclusion, PFNA2 has better stability, better rotatory stress shielding, superior compaction at fracture site, less blood loss, shorter operation time, less radiation exposure and better clinico-radiological outcomes. PFNA2 is a good implant choice to tackle the complex problems encountered in displaced unstable trochanteric fractures

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To Study the Functional Outcome of Primary Cemented Bipolar Hemiarthroplasty in the Management of Unstable Inter-Trochanteric Fracture of Femur among Elderly

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/0/v0/i0/729 ◽

2017 ◽

Vol 4 (1) ◽

pp. 78

Author(s):

Parth Vinod Agrawal ◽

Nitin Wagh ◽

Sandeep Pangavane

Keyword(s):

Care Center ◽

Weight Bearing ◽

Tertiary Care ◽

Trochanteric Fracture ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Cemented Bipolar Hemiarthroplasty ◽

A Prospective Study

Aims and Objectives: To evaluate the results with regard to function, to restoring proper limb length after surgery and to study the associated complications in intertrochanteric fractures treated by cemented bipolar hemiarthroplasty in elderly. Methodology: This is a prospective study of 25 cases of Intertrochanteric fractures admitted to a tertiary care center between August 2013 and November 2015 treated with Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures. Cases were taken according to inclusion and exclusion criteria. Results: In our study of 25 cases, there were 14 male and 11 female patients with mean age of 72.8 years. 80% of the cases admitted were due to trivial trauma, 20% due to RTA with left side being more common side affected. According to OTA classification Type 31A2.2 fractures accounted for 60% of cases & Type 31A2.3 accounted for 40 %.. Mean duration of hospital stay was 13.2 days and mean time of full weight bearing was 4.7days in our patients. Excellent was seen in 24% cases Fair to Good results were seen in 72% of cases in our study according to Harris Hip Score. Conclusion: From our study we conclude that Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures in elderly reduced the complications of prolonged immobilisation, prolonged rehabilitation, marked residual deformities and need for revision surgeries. The procedure offered, faster mobilization, rapid return to pre injury level, improved the quality of life.

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A Evaluation of Initial Treatment of Trochanteric Fractures using Gamma Nails

International Archives of Medicine ◽

10.3823/2619 ◽

2020 ◽

Vol 13 ◽

Author(s):

Quang-Tri LE ◽

Minh-Hoang Nguyen

Keyword(s):

Range Of Motion ◽

Initial Treatment ◽

Treatment Effectiveness ◽

Trochanteric Fracture ◽

The Elderly ◽

Bone Union ◽

Military Hospital ◽

Trochanteric Fractures ◽

Functional Rehabilitation ◽

Neck Shaft Angle

Background: Trochanteric fractures are extra-joint fractures, account for 55% of femoral proximal fractures. They often happen in the elderly with increased frequency due to age. Treatment experiences at 7A Military Hospital showed increased trochanteric fracture cases. To properly assess treatment effectiveness and select proper treatment methods, the study of “Evaluation of initial treatment of trochanteric fractures using gamma nails at 7A Military Hospital and made the conclusions of indications and applied techniques” was carried out. The study objectives are evaluating the initial treatment of trochanteric fractures using gamma nails at 7A Military Hospital and made the conclusions of indications and applied techniques. Methods and findings: nineteen patients diagnosed with traumatic trochanteric fractures and surgically treated with Gamma nails were monitored and evaluated for bone fusion, bone union, range of motion, limb shortening, and functional rehabilitation according to Merle D'Aubigné scale. Fourteen patients (82.35%) achieved proper bone union with the femoral neck-shaft angle of 1250 - 1300, three patients (17.65%) got slightly deviated bone union. Amongst patients aged under 60, 14/17 cases (82.35%) achieved “good” and “very good” functional rehabilitation, scored over 15 points according to Merle D΄aubigne Index; 3/17 cases (17.65%) got “average” recovery. Hip range of motion in 14 cases (82.35%) achieved “very good” (normal movement) or “good” (over 10% movement limitation) outcome, 3 cases had “average” movement (17.65%). Limb shortening of below 1cm took place in 10 patients (58.82%), 1 – 2 cm in 4 patients (23,53%) and over 3 cm in 3 patients (17.65%). Conclusions: The surgical treatment of trochanteric fractures using gamma nails yielded positive outcomes. Keywords: Gamma nails, trochanteric fractures, elderly, extra-joint.

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