Hip Pelvis.  2019 Jun;31(2):95-101. 10.5371/hp.2019.31.2.95.

Clinical Outcomes of U-blade Gamma3 Nails Used to Treat Patients with Trochanteric Fractures: Retrospective Multicenter Study

• Yoo J
• Kim S
• Jung H
• Hwang J

• KMID: 2448028
• DOI: http://doi.org/10.5371/hp.2019.31.2.95

Abstract

PURPOSE
This study was performed to assess the radiologic and clinical results of U-blade Gamma3 nail use for the treatment of trochanteric fractures.
MATERIALS AND METHODS
Between September 2015 and May 2018, all patients aged 65 years and older who underwent surgery with U-blade Gamma3 nails were analyzed. A total of 129 patients were selected based on having at least six months of follow-up. Image evaluations included bone quality (T-score), fracture classification on plain radiograph (AO/OTA), computed tomography configuration, union period, position of lag screw, anatomical reduction, tip apex distance (TAD), sliding extent of lag screw, change of neck shaft angle, and complications leading to reoperations were analyzed. Functional outcome were assessed using the Koval grade (ambulatory ability) at the final follow-up.
RESULTS
The mean time to union was 19.7 (range, 6-36) weeks. The screw position was centric (93 cases; 72.1%) and anatomical reduction was achieved in 74 cases (57.4%). The mean TAD was 20.3 (range, 12.3-38.1) mm. The mean sliding length of the lag screws was 3.8 (range, 0.1-12.6) mm. The mean change of neck shaft angle was 3.4° (range, 0-12.8°). Reoperations were required in two cases (1.6%) due to the cutting out of the lag screw (n=1) and metal failure with U-blade bending (n=1). Finally, Koval grades for 49.8% of patients reached preoperative status.
CONCLUSION
Overall, use of the U-blade Gamma3 nail led to favorable clinical results, suggesting that this system may be a good option for the treatment of trochanteric fractures.

Keyword

U-blade; Gamma3 nail; Trochanteric fracture; Femur

MeSH Terms

Classification
Femur*
Follow-Up Studies
Hip Fractures*
Humans
Neck
Retrospective Studies*

Figure

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  Fig. 1 Photograph of U-blade Gamma3 nail.

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  Fig. 2 Basal neck type fracture was defined as a fracture with the main fracture line between the base of the neck and the upper margin of the medial lesser trochanter, between the base of the neck base and one cm lateral to greater trochanter tip on three-dimensional computed tomography (CT) image. The blue zone is the trochanteric fracture zone. The red lines are suggestive of a basal neck fracture type upon CT scan.

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  Fig. 3 Fluoroscopic image of pulling the displaced medial cortex using a bone hook.

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  Fig. 4 (A) An 83-year-old woman suffered from a fall from height at home; the fracture type was reverse oblique (A32). (B) The fragment was reduced using a U-blade Gamma3 nail. (C) The lag screw was cut out of the head three months postoperatively. (D) The reoperation was converted to hemiarthroplasty.

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  Fig. 5 (A) A 93-year-old woman presented with a stable fracture (A11). (B) The three dimensional computed tomography scan revealed basilar neck fracture type. (C) The reduction was controlled using a U-blade Gamma3 nail (170 mm, 125°). (D) The lag screw was cut out and failure of U-blade occurred at one month postoperatively.

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