J Korean Fract Soc.  2011 Jan;24(1):1-6. 10.12671/jkfs.2011.24.1.1.

The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail

  • 1Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman's University School of Medicine, Seoul, Korea. ewhamdos@korea.com


To evaluate the efficiency of additional fixation of the alternative bone substitute in unstable intertrochanteric fractures treated with gamma nail and alternative bone substitute and only with gamma nail.
Radiologic comparison was done between forty-four patients of unstable intertrochanteric fracture (AO type A2.2, A2.3) during six months. The patients were divided into two groups, a group treated with gamma nail and alternative bone substitute (22 patients, group 1) and another group treated only with gamma nail (22 patients, group 2). Postoperative reduction status, Cleveland index, Tip-apex distance and complications during the follow-up period was compared. Lag screw slippage and femoral neck-shaft angle change were measured between two groups.
No significant difference of reduction status, Cleveland index and Tip-apex distance was found. In group II, there was a 1 more case of cutting-out of the lag screw, but also there was a significant difference. Lesser change in lag screw slippage and neck-shaft angle change was investigated.
As there are lesser lag screw slippage and neck-shaft angle change, alternative bone substitutes applied in unstable intertrochanteric fractures seems to be useful in maintaining reduction and preventing failure of internal fixation when proper reduction and screw insertion is performed.


Unstable intertrochanteric fracture; Gamma nail; Alternative bone substitute

MeSH Terms

Bone Substitutes
Follow-Up Studies
Hip Fractures
Bone Substitutes


  • Fig. 1 Injection of PolyBone. (A) Applying the specially manufactured guide and the pusher for insertion of PolyBone. (B) Injection of PolyBone into the guide and pushing to the lag screw insertion area by pusher. (C) C-arm radiograph after PolyBone injection to lag screw insertion site.

  • Fig. 2 Result of Cleveland index. (A) Result of Group I* - 20 of 22 patients (90.0%) inserted the lag screw in zone 5, 6, 8, 9. (B) Result of Group II† - 19 of 22 patients (86.3%) inserted the lag screw in zone 5, 6, 8, 9. *Group I: Fixation with gamma nail and PolyBone, †Group II: Fixation only with gamma nail.

  • Fig. 3 Result of neck shaft angle change and lag screw slippage. (A) Lesser change in femoral neck shaft angle is checked during 6 months in group I (p<0.001). (B) Also, there is lesser change in lag screw slippage during follow-up term in group I (p<0.001).


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