Orthopaedic Surgery and Traumatology Department, Clínico San Carlos Hospital, 5ª Planta, Ala Sur. Calle Profesor Martín Lagos s/n, 28004, Madrid, Spain.
Surgery Department, Complutense University, Madrid, Spain.
Arch Orthop Trauma Surg. 2022 Jan;142(1):145-155. doi: 10.1007/s00402-020-03668-0. Epub 2020 Nov 4.
New generation cephalomedullary nails are, currently, widely used for the treatment of trochanteric proximal femoral fractures. This study aims to compare the midterm outcomes and complication rates in patients with unstable 31A2 fractures treated with two different lengths of nails.
Retrospective study including 123 pertrochanteric proximal femoral fractures 31A2 treated with Gamma3 nail between January/2017 and January/2019. 19 patients were excluded, resulting in a total of 104 patients with a minimum follow-up of 1 year. Two groups, Long Dynamic Gamma3 Nail (LGN) and Short Static Gamma3 Nail (SGN), with 52 patients each were compared. Mean age was 81 years (range 50-99), being 78% female. Preoperative variables included: age, medical comorbidities, mobility, anesthetic risk, associated fractures, hemoglobin and hematocrit values. Postoperatively, functional and radiological results, quality of life, hemoglobin and hematocrit concentration, transfusion requirements, mobility, and pain were evaluated. Additionally, perioperative complications were also analyzed, such as malunion, non-union, infection rates, cut-outs, and peri-implant fractures.
A correct radiological fracture reduction was obtained in 73% of the cases (73% SGN/74% LGN). Two patients in LGN group had intraoperative complications (greater trochanter fractures). 38% of the patients with LGN presented nail tip impaction upon the distal anterior femoral cortex, associated with anterior knee pain. Blood loss and operative time was statistically different between groups. Despite the previous, no differences in clinical outcomes and quality of life were found.
The present study comparing two lengths of the Gamma3 Nail in 31A2 fractures showed no overall differences in clinical and radiological outcomes, and complication rates. However, the use of LGN was associated with a statistically significant higher blood loss and operative time, and a tendency for increased need for transfusion, and anterior knee pain and reoperation rate. Therefore, we recommend the use of locked SGN in the treatment of 31A2 fractures.
新一代的股骨近端髓内钉目前广泛应用于治疗股骨转子间近端骨折。本研究旨在比较两种不同长度的髓内钉治疗不稳定 31A2 骨折患者的中期结果和并发症发生率。
回顾性研究包括 2017 年 1 月至 2019 年 1 月期间采用 Gamma3 钉治疗的 123 例股骨转子间近端 31A2 骨折患者。排除 19 例患者，最终共有 104 例患者随访至少 1 年。比较了两组患者，长动力 Gamma3 钉（LGN）和短静态 Gamma3 钉（SGN），每组 52 例。平均年龄为 81 岁（范围 50-99 岁），其中 78%为女性。术前变量包括：年龄、合并症、活动能力、麻醉风险、合并骨折、血红蛋白和血细胞比容值。术后评估功能和影像学结果、生活质量、血红蛋白和血细胞比容浓度、输血需求、活动能力和疼痛。此外，还分析了围手术期并发症，如畸形愈合、不愈合、感染率、切出和植入物周围骨折。
73%（SGN 为 74%，LGN 为 73%）的病例获得了正确的影像学骨折复位。LGN 组有 2 例患者术中出现并发症（大转子骨折）。LGN 组有 38%的患者出现钉尖撞击股骨前皮质，伴有前膝疼痛。两组的失血量和手术时间存在统计学差异。尽管如此，两组在临床结果和生活质量方面并无差异。
本研究比较了两种长度的 Gamma3 钉在 31A2 骨折中的应用，发现临床和影像学结果以及并发症发生率没有总体差异。然而，使用 LGN 与统计学上显著较高的失血量和手术时间以及增加输血、前膝疼痛和再次手术的趋势相关。因此，我们建议在治疗 31A2 骨折时使用锁定的 SGN。
