PDF herunterladen
Osteosynthesis and Trauma Care 2005; 13(1): 18-25
DOI: 10.1055/s-2005-836371
Original Article

© Georg Thieme Verlag Stuttgart · New York

Fractures of the Proximal Femur. The Gamma Nail versus Plate

P. de Lucas1 , B. Seral1 , Á. Beano1 , J. A. Almodóvar1 , I. Domínguez1 , J. Rodríguez1 , E. Moro1
  • 1AIOD - España
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
24. März 2005 (online)

    Lizenzen und Reprints

Abstract

Historically the fractures of the proximal femur have been a challenge for the orthopaedic surgeon, because of the high number of hardware failures and the high mortality rate. The social and medical importance of these fractures is increasing and will be higher in the future because of the improved life expectancy and osteoporosis. The development of new material as well as the design of new devices have improved the results of treatment of this kind of fractures. Historically the plate was the treatment of choice for this kind of fractures, but the high incidence of hardware failures and non-unions led to the introduction of the Gamma nail which initiated a revolution in the concept of treatment of this kind of fractures. The main treatment target is to restore the functional capacity of the patient as soon as possible with the much higher mechanical guarantees of the device in order to obtain the fracture consolidation. A review of the medical literature has been done as well an evaluation of the two main concepts of treatment: plate versus endomedullary nail. Both techniques are not without risks, both have technical complications related to the technique. These complications can be resolved with an adequate learning curve. The experience of the surgeon is important to decrease these technical complications. Although it can lead to controversy about the treatment type for the stable fractures of the EPF, almost all the authors accept the endomedullary γ nail (Gamma nail) as the most adequate treatment of the unstable fractures of the proximal femur extremity.

Key words

Proximal femur - intertrochanteric, subtrochanteric fracture - Gamma nail - sliding hip screw - cut out

References

  • 1 Albareda J, Laclèriga A, Palanca D, Paniagua L, Seral F. Complications and technical problems with the Gamma nail.  Int Hop. 1996;  20 47-50
    CrossrefPubMedGoogle Scholar
  • 2 Almodóvar J A, De Lucas P L, Beano A. Fracturas pertrocantereas: estudio comparativo: DHS versus Clavo Gamma. Congreso de la SECOT, Tenerife 2003
    Google Scholar
  • 3 Almodóvar J A, De Lucas P, Ortega M A. Our experience in the long Gamma nail.  J Bone Joint Surg [Br]. 1997;  79 (Suppl 2) 197
    PubMedGoogle Scholar
  • 4 Apel D M, Patwardhan A, Pinzur M S. et al . Axial loading studies of unstable intertrochanteric fractures of the femur.  Clin Orthop. 1989;  246 156-164
    PubMedGoogle Scholar
  • 5 Aune A K, Ekeland A, Odegaars B, Alho A. Gamma nail vs compression hip screw for trochanteric femoral fractures.  Acta Orthop Scand. 1994;  65 127-130
    PubMedGoogle Scholar
  • 6 Baumgaertner M R, Curtin S L, Lindskog D M. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures.  Clin Orthop. 1998;  348 87-94
    PubMedGoogle Scholar
  • 7 Baumgaertner M R, Solberg B D. Awareness of tip-apex distance reduces failure of trochanteric fractures of the hip.  J Bone Joint Surg [Br]. 1997;  79 969-971
    PubMedGoogle Scholar
  • 8 Boriani S, De Lure F, Campanacci L. et al . A technical report reviewing the use of the 11 mm gamma nail.  Orthopaedics. 1996;  19 597-600
    PubMedGoogle Scholar
  • 9 Cardador L. International internal meeting, AIOD. Lisboa 2002
    Google Scholar
  • 10 Castrillo M A, Martinez P, Caceres J M, De Lucas P, Beano A. Clavo Gamma. Nuestra experiencia. Reintervenciones quirúrgicas. Congreso de la SECOT, Tenerife, España 2003
    Google Scholar
  • 11 Chevalley F, Gamba D. Gamma nailing of pertrochanteric and subtrochanteric fractures: Clinical results of series of 63 consecutive cases.  J Orthop Trauma. 1997;  11 412-415
    CrossrefPubMedGoogle Scholar
  • 12 De Lucas P, Beano A, Cobo J, Almodóvar J A. Tratamiento de las fracturas de la extremidad superior del fémur: Clavo Gamma. In: De Lucas P, Domínguez I (Eds). Manual de osteosintesis dinámica. Masson 2002; 87-97
    Google Scholar
  • 13 Dominguez I. et al .El cavo gamma: Estudio multicentrico. Reunión de la AIODE. Congreso de la SECOT. Sevilla 1993
    Google Scholar
  • 14 Evans E M. The treatment of trochanteric fractures of the femur.  J Bone Joint Surgery [Br]. 1949;  31 190-203
    PubMedGoogle Scholar
  • 15 Fornander P, Thorgren K G, Törnqvist H. et al . Swedish experience of the first 209 randomized patients with Gamma nail vs screw plate.  Acta Orthop Scand. 1992;  63 (Suppl 248) 90
    PubMedGoogle Scholar
  • 16 Frandsen P A, Kruse T. Hip fracture in the county of Funen, Denmark. Implications of demographic aging and changes in incidence rates.  Acta Orthop Scandinavica. 1983;  54 681-686
    PubMedGoogle Scholar
  • 17 Gehrchen P M, Nielsen J O, Olesen B. Poor reproducibility of Evans' classification of the trochanteric fracture: Assessment of 4 observers in 52 cases.  Acta Orthop Scand. 1993;  64 71-72
    PubMedGoogle Scholar
  • 18 Golhagen P R, O'Connor D R, Schwarze D. et al . A prospective comparative study of the compression hip screw and the Gamma nail.  J Orthop Trauma. 1994;  8 367-372
    PubMedGoogle Scholar
  • 19 Hardi D, Descamps P, Krallis P. et al . Use of an intramedullary hip-screw compared with a compresion hip-screw with a plate for intertrochanteric femoral fractures.  J Bone Joint Surg [Am]. 1998;  80 618-630
    PubMedGoogle Scholar
  • 20 Hogh J, Skou Andersen K, Duus B, Hansen D. Gamma nail versus DHS in the treatment of trochanteric and subtrochanteric hip fractures. AAOS, 1993 Annual Meeting, Paper No. 411. Februray 22, 1993
    Google Scholar
  • 21 Horz S, Lehle B. Finite element analysis of the mechanical behavior of internal fixation of pertrochanteric fractures using the Gamma nail. The Gamma locking nail. Ten years results and surgical experience 285-293. Einhorn-Presse Verlag, Reinbek 1999
    Google Scholar
  • 22 www.economiadelasalud.com/Ediciones/04/pdf/04_EnPortada_Prevencion.pdf . 
    Google Scholar
  • 23 Hughston D. Unstable intertrochanteric fractures of the hip.  J Bone Joint Surg [Am]. 1967;  49 440-450
    PubMedGoogle Scholar
  • 24 James E TR, Hunter G A. The treatment of intertrochanteric fractures. A review article.  Injury. 1983;  14 421-431
    CrossrefPubMedGoogle Scholar
  • 25 Jensen J S. Classification of trochanteric fractures.  Acta Orthop Scand. 1980;  51 803-810
    PubMedGoogle Scholar
  • 26 Kelsch G, Ulrich C. Evolution of treatment procedures for proximal femoral fractures. The Gamma locking nail. Ten years results and surgical experience 22-40. Einhorn-Presse Verlag, Reinbek 1999
    Google Scholar
  • 27 Kempf I, Grosse A, Taglang G. Le clou Gamma, L'enclouage centro-médullaire à foyer fermé des os longs selon Küntscher. Etat actuel. Cahiers d'enseignement de la SOFCOT. 47-54. Expansion Scientifique francaise, Paris 1990
    Google Scholar
  • 28 Koval K J, Zuckerman J D. Hip fractures: II. Evaluation and treatment of intertrochanteric fractures.  J Am Acad Orthop Surg. 1994;  2 150-156
    PubMedGoogle Scholar
  • 29 Kreusch-Brinker R, Rohlmann A, Jensen H I. Biomechanical investigations of the fatigue loading of internal fixation of the trochanter region of the femur. The Gamma locking nail. Ten years results and surgical experience 67-78. Einhorn-Presse Verlag, Reinbek 1999
    Google Scholar
  • 30 Kyle R F, Gustilo R B, Premer R F. Analysis of six hundred and twenty-two intertrochanteric hip fractures.  J Bone Joint Surg [Am]. 1979;  61 216-221
    PubMedGoogle Scholar
  • 31 Leung K S. International Trauma Course AIOD. Strasbourg, September 2003
    Google Scholar
  • 32 Leung K S, So W S, Shen W Y, Hui P W. Gamma nails and dynamic hip screws for pertrochanteric fractures: a randomised prospective study in elderly patients.  J Bone Joint Surg [Br]. 1992;  74 345-351
    Google Scholar
  • 33 Meislin R J, Zuckerman J D, Kummer F J. et al . A biomechanical analysis of the sliding hip screw. The question of plate angle.  J Orthop Trauma. 1990;  4 130-136
    PubMedGoogle Scholar
  • 34 Morales J, Uquillas G, De Lucas P. The Gamma nail in the treatment of pertrochanteric fractures. EFORT, Munich 1995
    Google Scholar
  • 35 Mulholland R C, Gunn D R. Sliding screw plate fixation of intertrochanteric femoral fractures.  J Trauma. 1972;  12 581-591
    PubMedGoogle Scholar
  • 36 Müller M E, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Springer-Verlag, Berlin, Heidelberg, New York 1990
    Google Scholar
  • 37 Parker M J, Pryor G A. Gamma versus nailing for extracapsular femoral fractures. Meta-analysis of ten randomised trials.  Int Orthop. 1996;  20 163-168
    CrossrefPubMedGoogle Scholar
  • 38 Parker M J, Handoll H HG, Robinson C M. Gamma nail versus sliding hip screw for the treatment of extracapsular femoral fractures (Cochrane Review). In: The Cochrane Library, Issue 4, 1998. Oxford: Update Software
    Google Scholar
  • 39 Radford P J, Needoff M, Webb J K. A prospective randomised comparison of the dynamic hip screw and the Gamma locking nail.  J Bone Joint Surg [Br]. 1993;  75 789-793
    PubMedGoogle Scholar
  • 40 Sarmiento A. Unstable intertrochanteric fractures of the femur.  Clin Orthop. 1973;  91 77-85
    PubMedGoogle Scholar
  • 41 Seral B, Albareda J, Lasierra J M, Seral F. Estudio clínico de la osteosintesis intra y extramedular en las fracturas trocantereas de cadera.  Rev Ortop Traumatol. 2001;  5 374-383
    PubMedGoogle Scholar
  • 42 Seral B, Garcia J M, Cegonino J, Doblare M, Seral F. Finite element study of intramedullary osteosynthesis in the treatment of trochanteric fractures of the hip: Gamma and PFN.  Injury. 2004;  35 130-135
    CrossrefPubMedGoogle Scholar
  • 43 Seral B, Gracia J, Cegoñimo J. et al . Osteosintesis extramedular vs intramedular en las fracturas trocantereas de cadera. Análisis 3D con elementos finitos.  Rev Ortop Traumatol. 2001;  2 126-136
    PubMedGoogle Scholar
  • 44 Sim E, Reiter T, Freimiller W, Rammerstorfer F G. Finite elemente analysis of the stress distribution in the proximal end of the femur after stabilization of a pertrochanteric model fracture: a comparsion of two implants. The Gamma locking nail. Ten years results and surgical experience 278-284. Einhorn-Presse Verlag, Reinbek 1999
    Google Scholar
  • 45 Taglang G, Schenck B. 2000 Gamma nails at Strasbourg CTO. 25 years of locking Gamma nail and 13 years AIOD. Strasbourg 1999
    Google Scholar
  • 46 Taglang G. Comunicacion personal. Strasbourg 2002
    Google Scholar
  • 47 Taglang G. The TGN (trochanteric Gamma nail). The Gamma locking nail. Ten years results and surgical experience. Einhorn-Presse Verlag, Leipzig 1999; 138-143
    Google Scholar
  • 48 Valverde Garcia J A. Tesis doctoral. UAM, Madrid 1995
    Google Scholar
  • 49 Wolfgang G L, Bryant M H, O'Neill J P. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation.  Clin Orthop. 1982;  163 148-158
    PubMedGoogle Scholar

Pablo de Lucas MD

Department of Cirugía Ortopedia y Traumatología · Hospital Ramón y Cajal · University of Alcala de Henares

Cta de Colmenar s/n

28035 Madrid

Spain

Telefon: +34/6 07 64 46 30

Fax: +34/9 16 23 65 29

eMail: pdelucas@ctv.es