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. 2024 Aug 29;58(4):209-214.
doi: 10.5152/j.aott.2024.23217.

Treatment outcomes of concomitant ipsilateral neck and trochanteric fractures using Gamma3 nails with U-blade lag screws

Ki Hyuk Sung  1 , So Hak Chung  1
Affiliations

Treatment outcomes of concomitant ipsilateral neck and trochanteric fractures using Gamma3 nails with U-blade lag screws

Ki Hyuk Sung et al. Acta Orthop Traumatol Turc. .

Abstract

This study aimed to investigate the outcomes of Gamma3 nails fitted with U-blade lag screws in the management of combined neck and trochanter fracture of the femur. Two hundred-fifty patients with fractures in the proximal femur underwent treatment using Gamma3 nails integrated with U-blade lag screws from 2015 to 2022. Among these cases, 33 had combined neck and trochanteric fractures; 8 patients were excluded because of follow-up for <1 year. The remaining data of 25 patients (7 males and 18 females) were reviewed. Bone mineral density (BMD), body mass index (BMI), tip-apex distance (TAD), extent of lag screw migration, femoral neck-shaft angle, callus formation, fracture type, and treatment failure were analyzed. The mean patient age was 76.3 (range, 61-91) years, and the mean follow-up duration was 17.3 (range, 12.5-57.3) months. The mean BMD T-scores for the spine and femoral neck were -2.3 ± 1.0 and -2.8 ± 0.7, respectively; 18 patients had T-scores ≤-2.5, indicating osteoporosis. The mean BMI was 23.2 ± 3.8 kg/m2 , and the mean operative time was 69.8 (range, 45-90) minutes. Twenty-one patients experienced injuries from slipping, 2 sustained injuries from falling, and 2 from car traffic accidents. The mean TAD was 21.6 ± 5.9 mm, with 16 patients showing <25 mm. The mean extent of lag screw migration was 5.7 ± 5.1 mm. The mean femoral neck-shaft angle on plain radiographs was 125.1 ± 8.6 degrees immediately postoperatively and 120.3 ± 9.5 degrees at the final follow-up. During the follow-up period, the first callus formation was observed at 3.8 months (range, 1.4-7.3) on plain radiographs in the anteroposterior and axial views. Based on our fracture criteria, 4 patients had a two-part fracture type, 12 patients had three-part, and 9 patients had four-part. Out of 25 patients, 3 exhibited treatment failure. No significant differences were observed between the groups with and without bone union regarding age, BMD, BMI, operative time, TAD of the lag screw, extent of lag screw migration, and femoral neck-shaft angle. The bone union was achieved in 88% of patients who underwent treatment utilizing the U-blade Gamma3 nail for concomitant ipsilateral neck and trochanteric fractures. Level IV, Therapeutic Study.

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Conflict of interest statement

Declaration of Interests: The authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
A-C. Anteroposterior view (A), computed tomography scan axial view (B), and coronal view (C) of the hips. These images show a two-part fracture involving the femoral neck and extending to the extracapsular region, which resulted in dissociation of the proximal femur into 2 distinct parts.
Figure 2.
Figure 2.
A-C. Anteroposterior view (A), computed tomography scan axial view (B), and coronal view (C) of the hips. These images show a three-part proximal femoral fracture involving the lesser trochanter, femoral neck, and distal part of the femur or involving the greater trochanter, femoral neck, and distal part of the femur.
Figure 3.
Figure 3.
A-C. Anteroposterior view (A), computed tomography scan axial view (B), and coronal view (C) of the hips. These images show a four-part proximal femoral fracture involving the greater trochanter, lesser trochanter, femoral neck, and distal part of the femur.
Supplementary Figure 1.
Supplementary Figure 1.
Photograph of a Gamma3 nail with a U-blade lag screw.
Supplementary Figure 2.
Supplementary Figure 2.
Illustration of a two-part fracture.
Supplementary Figure 3.
Supplementary Figure 3.
Illustration of three-part fracture.
Supplementary Figure 4.
Supplementary Figure 4.
Illustration of a four-part fracture.
Supplementary Figure 5.
Supplementary Figure 5.
Post-operative anteroposterior view image showing bone union 13 months after surgery for the two-part fracture.
Supplementary Figure 6.
Supplementary Figure 6.
Post-operative axial view image showing bone union 13 months after surgery for the two-part fracture.
Supplementary Figure 7.
Supplementary Figure 7.
Post-operative anteroposterior view image showing bone union 13 months after surgery for the three-part fracture.
Supplementary Figure 8.
Supplementary Figure 8.
Post-operative axial view image showing bone union 13 months after surgery for the three-part fracture.
Supplementary Figure 9.
Supplementary Figure 9.
Post-operative anteroposterior view image showing bone union 13 months after surgery for the four-part fracture.
Supplementary Figure 10.
Supplementary Figure 10.
Post-operative axial view image showing bone union 13 months after surgery for the four-part fracture.
Supplementary Figure 11.
Supplementary Figure 11.
Total anteroposterior view images showing the three-part fracture.
Supplementary Figure 12.
Supplementary Figure 12.
Immediate post-operative anteroposterior view.
Supplementary Figure 13.
Supplementary Figure 13.
screw cut-out images at 2.1 months of the follow-up period.
See this image and copyright information in PMC

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