Comparison of the Dyna Locking Trochanteric Nail, Proximal Femoral Nail Antirotation and Gamma 3 Nail in Treatment of Intertrochanteric Fracture of the Femur

Sung Soo Kim; Kyu Yeol Lee; Chul Hong Kim; Myung Jin Lee; Lih Wang; Hyeon Jun Kim; Sun Hyo Kim

doi:10.5371/hp.2013.25.3.211

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Kim, Lee, Kim, Lee, Wang, Kim, and Kim: Comparison of the Dyna Locking Trochanteric Nail, Proximal Femoral Nail Antirotation and Gamma 3 Nail in Treatment of Intertrochanteric Fracture of the Femur

Original Article

Hip & Pelvis 2013; 25(3): 211-219.

Published online: 30 September 2013

DOI: https://doi.org/10.5371/hp.2013.25.3.211

Comparison of the Dyna Locking Trochanteric Nail, Proximal Femoral Nail Antirotation and Gamma 3 Nail in Treatment of Intertrochanteric Fracture of the Femur

Sung Soo Kim, MD, Kyu Yeol Lee, MD, Chul Hong Kim, MD, Myung Jin Lee, MD, Lih Wang, MD, Hyeon Jun Kim, MD, Sun Hyo Kim, MD

Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea.

Address reprint request to Hyeon Jun Kim, MD. Department of Orthopaedic Surgery, College of Medicine, Dong-A University, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea. TEL: +82-51-240-2953, FAX: +82-51-243-6757, hyeonjun@dau.ac.kr

Received 20 April 2013 Revised 6 August 2013 Accepted 16 August 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to compare and analyze the radiological and clinical results after treatment of intertrochanteric fractures of the femur by three devices including DLT, PFNA and Gamma 3 nail.

Materials and Methods

From January 2007 to January 2012, we reviewed 131 patients who suffered intertrochanteric fractures(33 cases of DLT, 59 cases of PFNA, 39 cases of Gamma 3 nail). The following were measured for all three groups; The tip apex distance (TAD), neck shaft angle and lag screw position at the head of femur, as well as the amount of blood loss and transfusion, operation time, duration of hospitalization and postoperative ICU admission, complications were also assessed.

Results

In comparison of the radiological results, there were no statistical differences among the three groups in TAD, neck shaft angle and the lag screw position. There was no statistical difference in clinical results. In the last follow-up, there was one case of nonunion in the PFNA group. There also was, in the last follow up, a development of varus angulation & cut-out of lag screw that occurred in 2 cases (DLT), 4 cases (PFNA), 1 cases (Gamma 3). There was no statistical difference among the three groups in the sliding length of the lag screw.

Conclusion

Any certain group was not better than the others with regard to the radiological and clinical results among DLT, PFNA and Gamma nail groups in treating intertrochanteric fracture. To achieve favorable results, precise reduction of fracture site and surgical techniques are important.

Keywords: Femur, Intertrochanteric fracture, Dyna locking trochanter, Proximal femoral nail anti-rotation, Gamma 3 nail

Figures and Tables

Fig. 1

Photographs of lag screw of (A) DLT (Dyna Locking Trochanter), (B) PFNA (Proximal Femoral Nail Antirotation) and (C) Gamma 3 nail.

Fig. 2

(A) A 78-year old female patient presented with intertrochanteric fracture as AO/ASIF classification A2.2. (B) Immediate postoperative radiograph with PFNA (proximal femoral nail antirotation). (C) Immediate postoperative radiograph (lateral view). (D) Postoperative 1-year radiograph shows nonunion of fracture site. (E) Cementless bipolar hemiarthroplasty was performed at postoperative one year.

Table 1

Demographic Characteristics among the DLT, PFNA, and Gamma 3 Nail

^*Dyna Locking Trochanter, ^†Proximal Femoral Nail Antirotation, ^‡AO/ASIF classification A1.1, A1.2, A1.3, A2.1, ^§AO/ASIF classification A2.2, A2.3, ^∥Bone Mineral Density.

Table 2

Comparison of Intraoperative and Postoperative Results

Table 3

Comparison of Radiologic Results

^*Tip Apex Distance, ^†Neck Shaft Angle, ^‡Cleveland Index Zone 5, 6, 8, 9, ^§Cleveland Index Zone 1, 2, 3, 4, 7.

Table 4

Type of Complication

^*Femoral head cut out.

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