Browse > Article
http://dx.doi.org/10.5371/jkhs.2011.23.2.124

Comparison of the Gamma Nail and the Dynamic Hip Screw for Peritrochanteric Fracture  

Kweon, Seok-Hyun (Department of Orthopedic Surgery, College of Medicine, Wonkwang University, Institute of Wonkwang Medical Science)
Publication Information
Hip & pelvis / v.23, no.2, 2011 , pp. 124-130 More about this Journal
Abstract
Purpose: To retrospectively compare the clincal and radiological results between the gamma nail and dynamic hip screw (DHS) on the operative treatment of unstable peritrochanteric fractures. Materials and Methods: From January 1999 to December 2006, we selected 215 patients who could be observed at least 1 year among 246 patients who received surgical treatment for unstable peritrochanteric fractures in our hospital. Eighty-six patients were males and 129 were females; the mean age was 72 years. Evans unstable fracture was included in our study. The gamma nail was applied in 133 cases, and the dynamic hip screw was applied in 82 cases. We evaluated union times, the collapse intensity of fractured sites after union, hospitalization duration, operation time, and post-operative complications. Results: The mean union time was 15.7 weeks with the DHS and 13.7 weeks with the gamma nail. The collapse intensity of fracture sites were 3.5 mm and 1.9 mm, respectively. The mean hospital durations were 19.5 days for DHS surgery and 16.3 days for gamma nail surgery. The mean operation time was 85.5 minutes for DHS and 98.2 minutes for gamma nail. The post-operative complications were loosening of internal fixator (6 cases in DHS, 1 case in gamma nail), perforation of the femoral head (2 cases in DHS, 1 case in gamma nail), and non-union (7 cases in DHS, 2 cases in gamma nail). Conclusion: In unstable peritrochanteric fractures, biomechanically stable gamma nailing is thought to be one of the most effective treatments for reducing fracture site collapse and complications.
Keywords
Femur; Peritrochanteric fracture; Dynamic hip screw fixation; Gamma nailing;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Chung YK, Hwang JH, Kim HK. The treatment of peritrochanteric fracture of femur with proximal femoral nail-comparative study with dynamic hip screw. J Korean Hip Soc. 2007;19:167-75.
2 Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991;73:330-4.
3 Chang WS, Zuckerman JD, Kummer FJ, Frankel VH. Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures. Clin Orthop Relat Res. 1987;225:141-6.
4 Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 2001;83-A:643-50.
5 Chevalley F, Gamba D. Gamma nailing of pertrochanteric and subtrochanteric fractures: clinical results of a series of 63 consecutive cases. J Orthop Trauma. 1997;11:412-5.   DOI   ScienceOn
6 Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998;80:618-30.
7 Harrington P, Nihal A, Singhania AK, Howell FR. Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly. Injury. 2002;33:23-8.   DOI   ScienceOn
8 Kwun KW, Kim SK, Lee SW, Youn KH. Treatment of intertrochanteric fractures of the femur:comparison of the gamma nail and the dynamic hip screw. J Korean Orthop Assoc. 1993;28:1666-73.
9 Park MS, Kim KN. Intertrochanteric fractures of the femur treated with sliding hip compression screw and gamma nail -mechanical failure after internal fixation-. J Korean Hip Soc. 2000;12:102-11.
10 Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. 1993;75:789-93.
11 Mak PH, Campbell RC, Irwin MG. The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care. 2002;30:633-40.
12 Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993;75:797-8.
13 Evans EM. Trochanteric fractures; a review of 110 cases treated by nail-plate fixation. J Bone Joint Surg Br. 1951;33B:192-204.
14 Laskin RS, Gruber MA, Zimmerman AJ. Intertrochanteric fractures of the hip in the elderly: a retrospective analysis of 236 cases. Clin Orthop Relat Res. 1979;141:188-95.
15 Ross PM, Kurtz N. Subcapital fracture subsequent to Zickel nail fixation: a case report. Clin Orthop Relat Res. 1980;147:131-3.
16 Templeton TS, Saunders EA. A review of fractures in the proximal femur treated with the Zickel nail. Clin Orthop Relat Res. 1979;141:213-6.
17 Albareda J, Laderiga A, Palanca D, Paniagua L, Seral F. Complications and technical problems with the gamma nail. Int Orthop. 1996;20:47-50.   DOI   ScienceOn
18 Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury. 1995;26:615-8.   DOI   ScienceOn
19 Guyer P, Landolt M, Keller H, Eberle C. The Gamma Nail in per- and intertrochanteric femoral fractures-- alternative or supplement to the dynamic hip screw? A prospective randomized study of 100 patients with perand intertrochanteric femoral fractures in the surgical clinic of the City Hospital of Triemli, Zurich, September 1989 - June 1990. Aktuelle Traumatol. 1991;21:242-9.
20 Kaufer H, Matthews LS, Sonstegard D. Stable fixation of intertrochanteric fractures. J Bone Joint Surg Am. 1974;56:899-907.
21 Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients. J Bone Joint Surg Br. 1992;74:345-51.
22 Tarantino U, Oliva F, Impagliazzo A, et al. A comparative prospective study of dynamic variable angle hip screw and Gamma nail in intertrochanteric hip fractures. Disabil Rehabil. 2005;27:1157-65.   DOI   ScienceOn
23 Kim KC, Shin HK, Son KM, Ko CS. The treatment of unstable intertrochanter fracutures of femur:comparison between proximal femoral nail and dynamic hip screw. J Korean Fract Soc. 2005;18: 369-74.