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Randomized Controlled Trial
. 2012 Sep 1:20:60.
doi: 10.1186/1757-7241-20-60.

Is the lag screw sliding effective in the intramedullary nailing in A1 and A2 AO-OTA intertrochanteric fractures? A prospective study of Sliding and None-sliding lag screw in Gamma-III nail

Yi Zhu  1 , Severin Meili, Changqing Zhang, Congfeng Luo, Bing-fang Zeng
Affiliations
Randomized Controlled Trial

Is the lag screw sliding effective in the intramedullary nailing in A1 and A2 AO-OTA intertrochanteric fractures? A prospective study of Sliding and None-sliding lag screw in Gamma-III nail

Yi Zhu et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Object: To compare the Sliding with Non-sliding lag screw of a gamma nail in the treatment of A1 and A2 AO-OTA intertrochanteric fractures.

Materials and methods: 80 patients were prospectively collected. In each group, AO/OTA 31-A were classified into group A. AO/OTA 31-A2.1 was classified as group B. We classified the A2.2 and A2.3 as group C. According to the set-screw locking formation of Gamma-III, the cases were randomly allocated to Sliding subgroup and Non-sliding subgroup in A, B and C groups. Follow-ups were performed 1, 3, 6 and 12 months postoperatively.

Results: In the Sliding group, the bone healing rate 3, 6, 12 months postoperatively reached 85.00%, 97.50%, 100% in group A, B and C. Meanwhile, in Non-sliding group, postoperatively, bone healing rate were 90.00%, 95.00% and 97.50% in group A, B and C, respectively. Both differences were not significant. Lower limb discrepancy between Sliding and Non-sliding pattern was significantly different in group C which represent fracture types of AO/OTA 31-A2.2 and A2.3 (0.573 ± 0.019 mm in Non-sliding group, 0.955 mm ± 0.024 mm in Sliding group, P < 0.001 ). Difference of sliding distance among the three groups was significant among group A, B and C: 0.48 mm ± 0.04 mm, 0.62 mm ± 0.07 mm and 0.92 mm ± 0.04 mm (P < 0.001). Differences in average healing time and Harris scores also presented no significance in the three groups.

Conclusions: As a result, we can conclude that the sliding distance is minimal in Gamma nails and it is related to the comminuted extent of the intertrochanteric area in A1 and A2 AO-OTA intertrochanteric fractures. For treating these kinds of fractures, the sliding of the lag screw of an Gamma nail does not improve any clinical results and in certain cases, such as highly comminuted A1 and A2 fractures, can therefore even benefit from a locked lag screw by tightening the set-screw.

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Figures

Figure 1
Figure 1
The enrolled fracture types and grouping based on the AO/OTA classification: Group A: AO/OTA 31-A1; Group B: AO/OTA 31-A2.1; Group C: AO/OTA 31-A2.2, 2.3.
Figure 2
Figure 2
A schematic view of the lag screw sliding in the Gamma Nail. If the set screw was not tightened (as showed in A), after postoperative load bearing, the sliding of the lag screw (blue arrow) will allow fracture site impaction (B). If the set screw is tightened (C) no sliding will occur (D).
Figure 3
Figure 3
Flow Diagram for our RCT.
Figure 4
Figure 4
A. 47 years old, male (AO/OTA: 31-A1.2) B.1 month after operation C. 3 months after operation D. 6 months after operation E. 12 months after operation.
Figure 5
Figure 5
Lower limb discrepancy between Sliding and Non-sliding groups. P < 0.001. Mean ± SD, *Significantly different at p < 0.05.
Figure 6
Figure 6
Sliding distance in the Sliding group among groups A, B and C. P < 0.001. Mean ± SD. *significantly different at p < 0.05.
See this image and copyright information in PMC

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