Reduced complication rates for unstable trochanteric fractures managed with third-generation nails: Gamma 3 nail versus
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ORIGINAL ARTICLE
Reduced complication rates for unstable trochanteric fractures managed with third‑generation nails: Gamma 3 nail versus PFNA Felix Bonnaire1 · Thomas Lein1,2 · Tim Fülling1 · Philipp Bula1,3 Received: 12 February 2019 / Accepted: 28 July 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Introduction Third-generation nails for the management of unstable trochanteric fractures were evaluated with regard to outcomes. Patients and methods A prospective observational study comparing the Gamma 3 nail and the Proximal Femoral Nail Antirotation (PFNA) in 106 unstable trochanteric fractures confirms the recently reported low intra- and postoperative complication rates from retrospective cohort studies. Results Studies of same generations of both intramedullary nail systems did not reveal significant differences in intra- or postoperative complications. Intraoperative dislocation during nail insertion occurred 7 times for the Gamma nail and 9 times for the PFNA. The standard PFNA had to be exchanged intraoperatively for a shorter one on two occasions. Superficial wound healing disorders and hematoma requiring revision were observed in four patients in the Gamma 3 nail group and in three patients in the PFNA group. No deep infections were documented. Mechanical complications required revision in four patients (7.5%) after Gamma nailing and in two patients (3.8%) after PFNA. Postoperative rotation of the head–neck fragment was observed for the Gamma nail in three patients, not in the PFNA group. This was not statistically significant (p = 0.08). There were neither incidences of cut out without renewed trauma nor intraoperative fracture or postoperative femoral fracture. Nonunion affected 1 of 18 patients in late follow-up (p = 0.3) in the Gamma 3 nail group. Discussion The Gamma 3 nail and the PFNA yielded comparable clinical results and significantly improved outcomes for unstable trochanteric fractures compared to older nail generations. Keywords PFNA · Gamma 3 nail · Unstable trochanteric fractures · Proximal femur · Complications · Third-generation nails
Introduction There has been a marked increase in hip fractures due to the aging population. The majority of these worldwide are trochanteric fractures, which account for more than 50% [1–4]. After vertebral and wrist fractures, hip fractures are in third place for osteoporosis-associated fractures and give rise to about 61–72% of the overall costs [5]. With outgoings of * Felix Bonnaire felix.bonnaire@klinikum‑dresden.de 1
Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany
2
Diakonissenkrankenhaus Dresden, Holzhofgasse 29, 01099 Dresden, Germany
3
Klinikum Gütersloh, Reckenberger Str. 19, 33332 Dresden, Germany
about 5.4 billion Euro annually osteoporosis and its associated fractures are an extreme cost driver and can be regarded as the most expensive, endemic disorder in Germany [5]. They also lead to a much higher mortality rate in the year immediately after fr
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