Functional outcome of peritrochanteric fracture fixation with modified gamma nail using tri-wire anchorage
Keywords:Per-trochanteric fracture, Modified gamma nail, Tri-wire anchorage
Background: Pertrochanteric fractures comprise almost 50% of all proximal femoral fractures. Being common in elderly people, the quality of life deteriorates until the fracture is stabilized, followed by early mobilization. Intramedullary devices have been proven to improve biomechanics. In our study, we adopted modified gamma nail with additional tri-wire anchorage construct, which further stabilizes the rotational torque.
Methods: A prospective study was undertaken on 39 skeletally mature patients of both sexes, with per-trochanteric fracture, from January 2019 to April 2020. The study included 23 females and 16 males. the 34 underwent CRIF while 5 underwent ORIF. One patient was lost to follow-up. Clinico-radiological evaluations of the patients were done for 12 months. Functional evaluation was based on the modified Harris hip score (mHHS). Statistical analysis was done by SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism version 5.
Results: The study showed 100% union rate. Radiologically at 3 months, the fracture united in all patients. At 6 months postoperatively all patients were ambulatory with or without walking aids. One patient had tri-wire cut through and one had tri-wire back-out. HHS was an average of 79 at 3 months representing a fair outcome. This increased to 90 at 6 months representing an excellent outcome.
Conclusions: Modified gamma nail with tri-wire anchorage has distinct advantages over other techniques. It allows for early weight-bearing and mobilization with lesser complications. The tri-wire construct further provides additional rotational stability in osteoporotic bone.
nal stability in osteoporotic bone.
Rockwood Green’s, Fractures in adults 8th edition, volume 2 Wolters Kluwer. 2014.
Kovalak E, Ermutlu C, Atay T, Başal Ö. Management of unstable pertrochanteric fractures with proximal femoral locking compression plates and effect of neck-shaft angle on functional outcomes. J Clin Orthop Trauma. 2017; 8(3):209-14.
Jain MJ, Mavani KJ, Patel D. Role of provisional fixation of fracture fragments by Steinmann-pin and technical tips in proximal femoral nailing for intertrochanteric fracture. J Clin Diagnostic Res. 2017;11(6):RC01.
Pathrot D, Ul Haq R, Aggarwal AN, Nagar M, Bhatt S. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects. Indian J Orthop. 2016;50:269-76.
Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg. 1992;74(3):340-4.
Sharma V, Babhulkar S, Babhulkar S. Role of gamma nail in management of pertrochanteric fractures of femur. Indian J Orthop. 2008;42(2):212.
Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. A biomechanical evaluation of the Gamma nail. J Bone Joint Surg. 1992;74(3):352-7.
Badarou C, Louckou EA, Zakariyaou HI, Mohammed E, Mohammed S, Abdelhalim E et al. Outcomes of surgical management of per-trochanteric fractures: About 363 cases. J Orthop Trauma Surg Related Res. 2019;14(2).
Han L, Liu JJ, Hu YG, Quan RF, Fang WL, Jin B et al. Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall. Scientific Rep. 2018;8(1):1-6.
Papadimitriou N, Tsilidis KK, Orfanos P, Benetou V, Ntzani EE, Soerjomataram I et al. Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the chances consortium. Lancet Public Health. 2017;2(5):e239-46.
Torquato DF, Bordini AF, Ferreira G, Takata ET, Trigueiro G, Basile R. The correct implant choice for transtrochanteric fracture in Brazil. Acta Ortop Brasileira. 2016;24(6):327-9.
Knobe M, Pape HC. Anchorage strategies in geriatric hip fracture management. Innovative Surgical Sci. 2016;1(2):73-8.
Adam P. Treatment of recent trochanteric fracture in adults. Orthop Traumatol. 2014;100(1):S75-83.
Kumar N, Kataria H, Yadav C, Gadagoli BS, Raj R. Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique and mid-term follow up results. J Clin Orthop Trauma. 2014;5(3):137-45.
Aslan A, Baykal YB, Uysal E, Atay T, Kirdemir V, Baydar ML et al. Surgical treatment of osteopetrosis-related femoral fractures: two case reports and literature review. Case Rep Orthop. 2014;2014:891963.
Iwakura T, Niikura T, Lee SY, Sakai Y, Nishida K, Kuroda R et al. Breakage of a third-generation gamma nail: a case report and review of the literature. Case Rep Orthop. 2013;2013:172352.
Bellabarba C, Herscovici D, Ricci WM. Percutaneous treatment of peritrochanteric fractures using the Gamma nail. Clin Orthop. 2000;375:3-42.
Herrera A, Domingo LJ, Calvo A, Martínez A, Cuenca J. A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail. Int Orthop. 2002;26(6):365-9.
Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures: a randomized prospective study in elderly patients. J Bone Joint Surg. 1992;74:345-51.
Cheng CL, Chow SP, Pun WK. Long-term results and complications of cement augmentation in the treatment of unstable trochanteric fractures. Injury. 1989; 20(3):134-8.
Radford PJ, Needoff M, Webb JK. A prospective randomized comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg. 1993;75:789-93.