scholarly journals Outcomes of U-Blade Lag Screw for Cephalomedullary Fixation of Unstable Trochanteric Femur Fractures: A Case Control Study

2020 ◽  
Vol 11 ◽  
pp. 215145932097997
Author(s):  
Joon Soon Kang ◽  
Yong Tak Kwon ◽  
Young Ju Suh ◽  
Tong Joo Lee ◽  
Dong Jin Ryu
Keyword(s):  
Clinical Outcomes ◽  
Gamma Nail ◽  
Matched Pair ◽  
Fixation Failure ◽  
Lag Screw ◽  
Femur Fractures ◽  
Hip Screw ◽  
Matching Criteria ◽  
Gamma3 Nail ◽  
Sliding Distance

Background: Unstable trochanteric femur fractures in elderly patients with osteoporosis are still challenging. Gamma3 nail with the U-blade lag screw (U-blade gamma nail) has been developed to improve mechanical stability of proximal femoral fragment. This study aimed to compare the clinical and radiologic outcomes of U-blade gamma nail to proximal femoral nail antirotation (PFNA), and standard Gamma3 nail (gamma nail) for unstable trochanteric femur fractures. Methods: A retrospective matched-pair case study was performed with U-blade gamma nail, PFNA, and gamma nail. During 2012-2018, 970 patients with unstable trochanteric femur fractures were reviewed. Matching criteria were set as follows: 1) sex; 2) age (± 3 years); 3) body mass index (± 2 kg/m2); 4) bone mineral density (± 1 T-score in femur neck). Finally, a total of 159 patients were enrolled. We assessed the tip-apex distance (TAD), neck shaft angle, and hip screw sliding distance using plain radiographs. Also, we evaluated the clinical outcomes with Koval’s grade and fixation failure during 2 years. Results: The mean postoperative TAD was not significantly different among the 3 groups (p = 0.519). However, the change in the TAD at 1 year (p = 0.027) and 2 years (p = 0.008) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. The hip screw sliding distance at 1 year (p = 0.004) and 2 years (p = 0.001) after surgery was significantly smaller in U-blade gamma nail group compared with PFNA and gamma nail group. However, there was no significant difference of Koval’s grade and fixation failure among the 3 groups (p = 0.535). Conclusion: U-blade gamma nail showed favorable radiologic results in terms of the change in the hip screw position. However, U-blade gamma nail was not superior to PFNA and gamma nail in clinical outcomes.

scholarly journals Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others?

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jehyun Yoo ◽  
Sangmin Kim ◽  
Junyoung Choi ◽  
Jihyo Hwang
Keyword(s):  
Femoral Fractures ◽  
Walking Ability ◽  
Fixation Failure ◽  
Neck Shaft Angle ◽  
Lag Screw ◽  
Femur Fractures ◽  
Significant Difference ◽  
Shaft Angle ◽  
Sliding Distance ◽  
Screw Group

Abstract Background Intramedullary hip nails may be classified as blades or screws depending on the type of lag screw used. Recently, a combination of lag screw types with a U-clip insertion has also been used. The purpose of this study was to evaluate the clinical and radiological outcomes of these new screw types. Methods A total of 185 patients with trochanteric femoral fractures (age ≥ 65 years) who underwent surgery with intramedullary nails were selected. Surgeries with InterTrochanteric/SubTrochanteric (ITST), Proximal Femoral Nail Antirotation (PFNA), and Gamma 3 U-Blade lag screws were performed between January 2011 and June 2016. The AO/OTA classification, presence of a basicervical fracture type on 3D-CT, BMI, BMD, reduction quality, position of the lag screw, TAD (tip apex distance) of the lag screw, sliding distance of the lag screw, varus change (neck shaft angle), radiological union period, fixation failure and functional outcome as determined by walking ability were analyzed. Results There were 3/60 (5.0%) cases of fixation failure in the ITST group, all caused by cut-out; 4/57 (7.0%) in the PFNA II group: 3 caused by cut-through and 1 by metal fracture; 1/68 (1.5%) in the Gamma 3 U-Blade lag screw group (P = 0.301). In each group, the sliding distance of the lag screw showed a significant difference (P = 0.017), whereas significant sliding over 10 mm showed no statistically significant results. Conclusion There was only one (1.5%) case of fixation failure in the Gamma 3 U-Blade lag screw group. The sliding distance of the U-Blade was found to be in the middle, between the PFNA II (shorter) and ITST (longer) implants. The new rotational control lag screw seems to be comparable to other screw types.

scholarly journals Intertrochanteric fracture fixation with Dynamic Hip Screw: Is tip-apex distance measurement useful for predicting fixation failure?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Goh KL ◽  
Zamzuri Z ◽  
Mohd Ariff S ◽  
Mohamed Azril MA
Keyword(s):  
Intertrochanteric Fracture ◽  
Demographic Data ◽  
Dynamic Hip Screw ◽  
Optimal Placement ◽  
Fixation Failure ◽  
Lag Screw ◽  
Hip Screw ◽  
Tip Apex Distance ◽  
One Year

Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.

Treatment of Intertrochanteric Fracture with Dynamic Hip Screw and Gamma Nail: A Retrospective Matched Pair Study

2001 ◽  
Vol 36 (5) ◽  
pp. 423 ◽  
Author(s):  
Joon Soon Kang ◽  
Seung Rim Park ◽  
Hyung Soo Kim ◽  
Woo Hyeong Lee ◽  
Ki Wook Kim ◽  
...  
Keyword(s):  
Intertrochanteric Fracture ◽  
Gamma Nail ◽  
Dynamic Hip Screw ◽  
Matched Pair ◽  
Hip Screw

Biomechanical analysis of the cephalomedullary nail versus the trochanteric stabilizing plate for unstable intertrochanteric femur fractures

2016 ◽  
Vol 230 (12) ◽  
pp. 1133-1140 ◽  
Author(s):  
David Walmsley ◽  
Bruce Nicayenzi ◽  
Paul RT Kuzyk ◽  
Alan Machin ◽  
Habiba Bougherara ◽  
...  
Keyword(s):  
Biomechanical Analysis ◽  
Intertrochanteric Fractures ◽  
Cephalomedullary Nail ◽  
Sliding Hip Screw ◽  
New Device ◽  
Locking Screws ◽  
Femur Fractures ◽  
Proximal Extension ◽  
Hip Screw ◽  
Gamma3 Nail

Unstable intertrochanteric fractures are commonly treated with a cephalomedullary nail due to high failure rates with a sliding hip screw. The Omega3 Trochanteric Stabilizing Plate is a relatively new device that functions like a modified sliding hip screw with a proximal extension; however, its mechanical properties have not been evaluated. This study biomechanically compared a cephalomedullary nail, that is, Gamma3 Nail against the Omega3 plate. Unstable intertrochanteric fractures were created in 24 artificial femurs. Experimental groups were as follows: Nail (i.e. Gamma3 Nail) (n = 8), Plate A (i.e. Omega3 plate with four distal non-locking screws and no proximal locking screws) (n = 8), Plate B (i.e. Plate A plus five proximal locking screws) (n = 8), Plate C (i.e. Omega3 plate with three distal locking screws and no proximal locking screws) (n = 8), and Plate D (i.e. Plate C plus five proximal locking screws) (n = 8). All specimens were stiffness tested, while the Nail and Plate D groups were also strength tested. For lateral bending, Plate B was less stiff than the Nail (p = 0.001) and Plate A (p = 0.009). For torsion, Plate A was less stiff than Plate D (p = 0.020). For axial compression, the Nail was less stiff than Plate A (p = 0.036) and Plate B (p = 0.008). Axial strength for the Nail (5014 ± 308 N) was 66% higher than the Plate D construct (2940 ± 411 N) (p < 0.001). All Nails failed by partial or complete cutout through the femoral head and neck, but Plate D failed by varus collapse and deformation of the lag screw. When the cephalomedullary nail is clinically contra-indicated, this study supports the use of the Omega3 plate, since it had similar stiffness in three test modes to the Gamma3 Nail, but had lower strength. Stability of Omega3 plate constructs was not improved with locked fixation proximally or distally.

FAILURE OF COMPRESSION HIP SCREW: ANALYSIS OF THE FAILURE MECHANISM

2002 ◽  
Vol 06 (02) ◽  
pp. 101-106
Author(s):  
Chi-Wei Chang ◽  
Kuo-An Lai ◽  
Chyun-Yu Yang
Keyword(s):  
Statistical Analysis ◽  
Fixation Device ◽  
Old People ◽  
Failure Group ◽  
Lag Screw ◽  
Cutting Out ◽  
Cause Of Failure ◽  
Hip Screw ◽  
Sliding Distance ◽  
Unstable Fractures

Compression hip screw is a well-accepted fixation device for peritrocahnteric fractures in old people. However, mechanical failures of the device were frequently reported, most of them condemned osteoporosis as the major cause of failure. Few reports discussed the pitfalls of the design of the device. We retrospectively reviewed 205 cases of peritrochanteric fracture treated in our institute with compression hip screw from 1998 to 2001. Fifteen patients (7.3%) had mechanical failure, where 14 of them (93.3%) were cutting out of the lag screw. Statistical analysis found that mechanical failures of the compression hip screw were more often in women than men (p < 0.05) and more often in unstable fractures (Boyd and Griffin types III and IV) than stable fractures (types I and II). The length of the lag screw (average 80.6 mm, range 75–95 mm) in the failure group was significantly shorter than that of the non-failure group (average 85.4 mm, range 75–100 mm) (p < 0.05). The Aesculap Compression hip screw used in our institute has a barrel length of 38 mm and a threaded part of the lag screw 24 mm in length. The average sliding capacity for the failure group was only 18.6 and was not enough for the fracture settling. Fourteen patients had the lag screw cut out of the femoral head at the end of sliding of the fixation device. We suggest application of a device with a shorter barrel and threaded part for patients with short femoral necks to gain more sliding distance in order to reduce the failure rate.

Peritrochanteric Fractures of the Femur: A Comparison between the Ender Nail, Gamma Nail and Dynamic Hip Screw

1996 ◽  
Vol 6 (1) ◽  
pp. 29-39 ◽  
Author(s):  
J.A. De Pedro ◽  
J. Rey ◽  
R. Lopez-Casero ◽  
A.J. Perez-Cab Aller ◽  
I Dominguez ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Operation Time ◽  
Clinical Results ◽  
Gamma Nail ◽  
Dynamic Hip Screw ◽  
Bony Union ◽  
Early Weight Bearing ◽  
Femur Fractures ◽  
Fracture Configuration ◽  
Hip Screw

Surgical fixation, early weight-bearing, and bony union remain a challenge in the treatment of peritrochanteric femur fractures, especially if the fractures are comminuted or unstable. A randomized prospective study of 154 fractures treated by either the Gamma nail (43), Dynamic Hip Screw (DHS) (30) or Ender's nail (81) is reported. The average follow-up for Ender's nails was 36.7 months; for DHS 39.4 months and for Gamma nails 37.3 months. The Ender's nails required a significantly (p<0.001) shorter operation time of 42±13.4 min. The Gamma nail group required a higher mean duration of screening, 193±92 sec. Few screws in either group were in a bad position, but 12 (32%), in the Gamma nail group, and 2 (10%) in the DHS were placed superiorly in the head. From this experience, the Gamma nail appears to allow for early patient ambulation regardless of the fracture configuration with good clinical results, but the potential advantages of the Gamma nail are still unclear in these already compromised patients.

scholarly journals Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seungbae Oh ◽  
Yong-Sik Kim ◽  
Soon-Yong Kwon ◽  
Jiyoung Jung ◽  
Chiyoung Yoon ◽  
...  
Keyword(s):  
Case Series ◽  
Limb Length ◽  
Leg Length ◽  
Propensity Score Matching Analysis ◽  
Lag Screw ◽  
Significant Difference ◽  
Trauma Surgeons ◽  
Gamma3 Nail ◽  
Sliding Distance ◽  
Limb Length Inequality

AbstractThe purpose of this study is to compare the cut-out rate and sliding distance associated with limb length inequality between operations using a standard non-sliding lag screw versus those using a non-sliding lag screw with U-blade (RC) in the Gamma3 nail. This is a retrospective review of two case series involving different lag screws for the Gamma3 nail. Propensity score matching analysis was used to adjust the confounding factors. A comparative analysis of 304 patients who treated with Gamma3 nail with either a standard non-sliding lag screw or a U-Blade (RC) lag screw was performed. Between 2014 and 2018, 152 patients were treated with U-blade (RC) lag screws, and these patients were matched with those treated with standard lag screws. There was no significant difference in cut-out rate between groups. However, additional use of anti-rotation U-blade (RC) could significantly decrease lag screw sliding, with the group treated with U-Blade (RC) lag screws exhibiting shorter sliding, especially in AO/OTA31 A2 and A3 fractures. Also, in A2 and A3 fractures, the mean lag screw sliding distance was greater than that seen in A1 fractures in both groups. These findings can help trauma surgeons choose the proper implant to reduce leg length inequality.

scholarly journals A comparison between Asians and Caucasians in the dimensions of the femoral isthmus based on a 3D-CT analysis of 1189 adult femurs

2021 ◽  
Author(s):  
Darius M. Thiesen ◽  
Dimitris Ntalos ◽  
Alexander Korthaus ◽  
Andreas Petersik ◽  
Karl-Heinz Frosch ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Strong Predictor ◽  
Matched Pair ◽  
3D Ct ◽  
Femur Fractures ◽  
Matched Pair Analysis ◽  
Significant Difference ◽  
Ct Analysis ◽  
Ct Data ◽  
The Individual

Abstract Introduction For successful intramedullary implant placement at the femur, such as nailing in unstable proximal femur fractures, the use of an implant that at least reaches or exceeds the femoral isthmus and yields sufficient thickness is recommended. A number of complications after intramedullary femoral nailing have been reported, particularly in Asians. To understand the anatomical features of the proximal femur and their ethnic differences, we aimed to accurately calculate the femoral isthmus dimensions and proximal distance of Asians and Caucasians. Methods In total, 1189 Asian and Caucasian segmented 3D CT data sets of femurs were analyzed. The individual femoral isthmus diameter was precisely computed to investigate whether gender, femur length, age, ethnicity or body mass index have an influence on isthmus diameters. Results The mean isthmus diameter of all femurs was 10.71 ± 2.2 mm. A significantly larger diameter was found in Asians when compared to Caucasians (p < 0.001). Age was a strong predictor of the isthmus diameter variability in females (p < 0.001, adjusted r2 = 0.299). With every year of life, the isthmus showed a widening of 0.08 mm in women. A Matched Pair Analysis of 150 female femurs showed a significant difference between isthmus diameter in Asian and Caucasian femurs (p = 0.05). In 50% of the cases the isthmus was found in a range of 2.4 cm between 16.9 and 19.3 cm distal to the tip of the greater trochanter. The female Asian femur differs from Caucasians as it is wider at the isthmus. Conclusions In absolute values, the proximal isthmus distance did not show much variation but is more proximal in Asians. The detailed data presented may be helpful in the development of future implant designs. The length and thickness of future standard implants may be considered based on the findings.

scholarly journals Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 763
Author(s):  
Tiago Martinho ◽  
Karl Stoffel
Keyword(s):  
High Risk ◽  
Surgical Technique ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Older Patients ◽  
Bipolar Hemiarthroplasty ◽  
Intramedullary Nails ◽  
Fixation Failure ◽  
Femur Fractures

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

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