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Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs

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Abstract

We report a randomised prospective study comparing two implants, the Gamma trochanteric nail and the ACE trochanteric nail, in the treatment of intertrochanteric femoral fractures in the elderly. One hundred and twelve patients were randomised on admission into two treatment groups. Fifty-six patients were treated with Gamma nail implants, and 56 were treated with ACE trochanteric nail. The average age of these patients was 78 years. Twenty fractures were stable and 92 unstable. The mean follow-up time was 8 months (6 –12). Regular clinical and radiological review was done 1, 3 and 6 months postoperatively. Operation time, fluoroscopy time, blood transfusion and complications were recorded. The mobility score was used to assess the pre-injury and postoperative mobility status. All the patients were treated within 36 h of their accident. There were no complications during surgery. All the patients were mobilised in the first 24 h postoperatively, regardless of the fracture type, and weight bearing was permitted as tolerated. Union of the fracture was achieved in all patients. There was no statistically significant difference between the two groups with regard to the studied parameters. There was no mechanical failure of the implants despite the early patient mobilisation. Early operation and early mobilisation resulted in a good functional outcome in all patients. Both the trochanteric gamma nail and ACE trochanteric nail provide effective methods of treatment for intertrochanteric fractures in elderly patients.

Résumé

nous rapportons une étude randomisée prospective comparant deux implants : le clou gamma et le clou ACE dans le traitement des fractures inter trochantériennes fémorales chez les sujets âgés. Cent douze patients ont été randomisés à l’admission avec deux groupes de traitement; 56 patients ont été traités avec le clou gamma et 56 avec le clou ACE. L’âge moyen de ces patients est de 78 ans. Vingt fractures étaient stables, 92 instables. Le suivi moyen était de 8 mois (6 à 12 mois). Une surveillance clinique et radiographique a été réalisée à 1,3 et 6 mois post-opératoire. Le temps opératoire, le temps d’amplificateur de brillance, la transfusion sanguine, le taux de transfusion sanguine et les complications ont été rapportés. La mobilité pré traumatique des patients et le statut d’indépendance post-opératoire ont été rapportés. Tous les patients ont été opérés dans les 36h00 après l’accident. Il n’y a aucune complication durant la chirurgie. Tous les patients ont été mobilisés à 24h00 post-opératoire quels que soient le type de fractures et l’appui a été autorisé. La consolidation de la fracture a été obtenue chez tous les patients. Il n’y a pas de différence significative entre les deux groupes. Il n’y a pas eu de problèmes mécaniques sur les implants, malgré la mobilisation précoce des patients. Une opération précoce et une mobilisation précoce entraînent un bon résultat et un bon devenir chez ces patients. Les deux clous, gamma ou ACE représentent une méthode effective du traitement des fractures inter-trochantérienne chez les sujets âgés.

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Authors and Affiliations

  1. Orthopaedic Department, Athens University, “Agia Olga” Hospital, Megalou Alexandrou 54, Maroussi, Athens, 15124, Greece

    Nicolas E. Efstathopoulos, Vassilios S. Nikolaou & John T. Lazarettos

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  1. Nicolas E. Efstathopoulos
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  2. Vassilios S. Nikolaou
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  3. John T. Lazarettos
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Correspondence to Vassilios S. Nikolaou.

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Efstathopoulos, N.E., Nikolaou, V.S. & Lazarettos, J.T. Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. International Orthopaedics (SICO 31, 71–76 (2007). https://doi.org/10.1007/s00264-006-0128-5

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  • DOI: https://doi.org/10.1007/s00264-006-0128-5

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