Intramedullary fixation of high subtrochanteric femoral fractures: a study comparing two implant designs, the Gamma nail and the intramedullary hip screw.

摘要

OBJECTIVE: To compare two implants, the Gamma nail and the intramedullary hip screw (IMHS ), in the treatment of high subtrochanteric femoral fractures. STUDY DESIGN: Prospective, nonrandomized clinical study. METHODS: Eighty-seven consecutive patients with high subtrochanteric fractures of the Russell-Taylor Types 1A and 1B were treated with intramedullary fixation. The first fifty patients were treated with the Gamma nail and the next thirty-seven with the IMHS. The results of these operations were evaluated after a minimum follow-up of twelve months, and special emphasis was put on the complication rate. RESULTS: The number of noninfectious complications (intraoperative fractures, postoperative refractures and fixation failures) was significantly higher (p = 0.037) in the Gamma group (11 of 50, 22 percent) than in the IMHS group (2 of 37, 5 percent). The complication most often associated with the Gamma nail, postoperative fracture of the femoral shaft (six in our Gamma group), was not encountered with the use of the IMHS. The Gamma group also included three cases of intraoperative trochanteric extension of the fracture versus none in the IMHS group. The IMHS group included two mechanical fixation failures. CONCLUSIONS: The lower complication rate associated with the use of the IMHS implant could be attributable in part to the learning curve in the use of intramedullary implants. However, we consider that the evolution of the implant design contributes to the result.