A clinical study on the relationship of the tail femur distance and the lag screw migration or cutting-out after the third generation of Gamma nail fixation of intertrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HOU Yu , YAO Qi , ZHANG Gen’ai ,  DING Lixiang

Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, P.R.China;

Corresponding author：

DING Lixiang, Email: dinglixiang@medmail.com

Keywords：

Intertrochanteric fracture of the femur; the third generation of Gamma nail; lag screw migration or cutting-out; tail femur distance

DOI：

10.7507/1002-1892.201709009

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Objective To confirm the association between tail femur distance (TFD) and lag screw migration or cutting-out in the treatment of intertrochanteric fracture with the third generation of Gamma nail (TGN). Methods The clinical data of 124 cases of intertrochanteric fracture treated with TGN internal fixation and followed up more than 18 months between January 2012 and December 2015 were reviewed and analyzed. There were 52 males and 72 females, with an age of 46-93 years (mean, 78.5 years). According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, 43 cases were type 31-A1, 69 cases were type 31-A2, and 12 cases were type 31-A3. The time from injury to operation was 1-10 days (mean, 2.9 days). According to the fracture healing of the patients, the patients were divided into the healing group and failure group. The age, gender, height, bone mineral density (BMD), fracture AO/ASIF classification, the time from injury to operation, and the TFD value at 1 day after operation were recorded and compared. The risk factors for the migration or cutting-out of lag screw were analyzed by logistic regression. Results There were 111 cases in healing group, the healing time was 80-110 days (mean, 95.5 days). There were 13 cases in failure group, including 2 cases of lag screw cutting-out and 11 cases of significant migration. Except for the TFD value at 1 day after operation in failure group was significantly higher than that in the healing group(t=5.14, P=0.00), there was no significant difference in gender, age, height, BMD, fracture of AO/ASIF classification, and the time from injury to operation (P>0.05) between 2 groups. logistic regression analysis showed that TFD value was a risk factor for the migration or cutting-out of lag screw (B=1.22, standardized coefficient=0.32, Wald χ²=14.66, P=0.00, OR=3.37). Conclusion The patients with higher TFD value had higher risk of postoperative lag screw migration or cutting-out. This result indicates that the appropriate length of the lag screw is helpful to reduce TFD value and prevent postoperative lag screw migration or cutting-out.

Citation： HOU Yu, YAO Qi, ZHANG Gen’ai, DING Lixiang. A clinical study on the relationship of the tail femur distance and the lag screw migration or cutting-out after the third generation of Gamma nail fixation of intertrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 40-44. doi: 10.7507/1002-1892.201709009 Copy

1.	Georgiannos D, Lampridis V, Bisbinas I. Complications following Treatment of Trochanteric Fractures with the Gamma3 Nail: Is the Latest Version of Gamma Nail Superior to Its Predecessor? Surg Res Pract, 2014, 2014: 143598.
2.	Hopp S, Wirbel R, Ojodu I, et al. Does the implant make the difference ?-Prospective comparison of two different proximal femur nails. Acta Orthop Belg, 2016, 82(2): 319-331.
3.	Lang NW, Joestl J, Payr S, et al. Secondary femur shaft fracture following treatment with cephalomedullary nail: a retrospective single-center experience. Arch Orthop Trauma Surg, 2017, 137(9): 1271-1278.
4.	Kuzyk PR, Zdero R, Shah S, et al. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma, 2012, 26(7): 414-421.
5.	Santoni BG, Nayak AN, Cooper SA, et al. Comparison of Femoral Head Rotation and Varus Collapse Between a Single Lag Screw and Integrated Dual Screw Intertrochanteric Hip Fracture Fixation Device Using a Cadaveric Hemi-Pelvis Biomechanical Model. J Orthop Trauma, 2016, 30(4): 164-169.
6.	Tsai SW, Lin CJ, Tzeng YH, et al. Risk factors for cut-out failure of Gamma3 nails in treating unstable intertrochanteric fractures: An analysis of 176 patients. J Chin Med Assoc, 2017, 80(9): 587-594.
7.	Helwig P, Faust G, Hindenlang U, et al. Finite element analysis of four different implants inserted in different positions to stabilize an idealized trochanteric femoral fracture. Injury, 2009, 40(3): 288-295.
8.	Faisal TR, Luo Y. Study of stress variations in single-stance and sideways fall using image-based finite element analysis. Biomed Mater Eng, 2016, 27(1): 1-14.
9.	Nüchtern JV, Ruecker AH, Sellenschloh K, et al. Malpositioning of the lag-screws by one- or two-screw nailing systems for pertrochanteric femoral fractures: a biomechanical comparison of Gamma3 and Intertan. J Orthop Trauma, 2014, 28: 276-282.
10.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
11.	Andruszkow H, Frink M, Fromke C, et al. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. Int Orthop, 2012, 36(11): 2347-2354.
12.	Yang S, Liu Y, Yang T, et al. Early Clinical Efficacy Comparison Study of Gamma3 Nail, Percutaneous Compression Plate (PCCP) and Femoral Head Replacement (FHR) Treatment on Senile Unstable Intertrochanteric Fractures. J Invest Surg, 2017. [Epub ahead of print].
13.	Mingo-Robinet J, Torres-Torres M, Martínez-Cervell C, et al. Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases. J Orthop Trauma, 2015, 29(3): e85-90.
14.	Yang JC, Chen HC, Lai YS. Measurement of Tip Apex Distance and Migration of Lag Screws and Novel Blade Screw Used for the Fixation of Intertrochanteric Fractures. PLoS One, 2017, 12(1): e0170048.
15.	陈太勇, 李开南, 汪学军, 等. Gamma钉内固定翻修原因及其疗效. 中国修复重建外科杂志, 2010, 24(1): 78-81.
16.	Serrano R, Blair JA, Watson DT, et al. Cephalomedullary nail fixation Of intertrochanteric fractures: are two proximal screws better than one? J Orthop Trauma, 2017, 31(11): 577-582.
17.	Kuzyk PR, Shah S, Zdero R, et al. A biomechanical comparison of static versus dynamic lag screw modes for cephalomedullary nails used to fix unstable peritrochanteric fractures. J Trauma Acute Care Surg, 2012, 72(2): E65-70.
18.	Born CT, Karich B, Bauer C, et al. Hip screw migration testing: first results for hip screws and helical blades utilizing a new oscillating test method. J Orthop Res, 2011, 29(5): 760-766.
19.	江伟, 刘跃洪, 杨灵, 等. 股骨近端锁定钢板与Gamma3治疗稳定型股骨转子间骨折的生物力学比较研究. 中国修复重建外科杂志, 2014, 28(9): 1096-1099.

1. Georgiannos D, Lampridis V, Bisbinas I. Complications following Treatment of Trochanteric Fractures with the Gamma3 Nail: Is the Latest Version of Gamma Nail Superior to Its Predecessor? Surg Res Pract, 2014, 2014: 143598.
2. Hopp S, Wirbel R, Ojodu I, et al. Does the implant make the difference ?-Prospective comparison of two different proximal femur nails. Acta Orthop Belg, 2016, 82(2): 319-331.
3. Lang NW, Joestl J, Payr S, et al. Secondary femur shaft fracture following treatment with cephalomedullary nail: a retrospective single-center experience. Arch Orthop Trauma Surg, 2017, 137(9): 1271-1278.
4. Kuzyk PR, Zdero R, Shah S, et al. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma, 2012, 26(7): 414-421.
5. Santoni BG, Nayak AN, Cooper SA, et al. Comparison of Femoral Head Rotation and Varus Collapse Between a Single Lag Screw and Integrated Dual Screw Intertrochanteric Hip Fracture Fixation Device Using a Cadaveric Hemi-Pelvis Biomechanical Model. J Orthop Trauma, 2016, 30(4): 164-169.
6. Tsai SW, Lin CJ, Tzeng YH, et al. Risk factors for cut-out failure of Gamma3 nails in treating unstable intertrochanteric fractures: An analysis of 176 patients. J Chin Med Assoc, 2017, 80(9): 587-594.
7. Helwig P, Faust G, Hindenlang U, et al. Finite element analysis of four different implants inserted in different positions to stabilize an idealized trochanteric femoral fracture. Injury, 2009, 40(3): 288-295.
8. Faisal TR, Luo Y. Study of stress variations in single-stance and sideways fall using image-based finite element analysis. Biomed Mater Eng, 2016, 27(1): 1-14.
9. Nüchtern JV, Ruecker AH, Sellenschloh K, et al. Malpositioning of the lag-screws by one- or two-screw nailing systems for pertrochanteric femoral fractures: a biomechanical comparison of Gamma3 and Intertan. J Orthop Trauma, 2014, 28: 276-282.
10. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
11. Andruszkow H, Frink M, Fromke C, et al. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. Int Orthop, 2012, 36(11): 2347-2354.
12. Yang S, Liu Y, Yang T, et al. Early Clinical Efficacy Comparison Study of Gamma3 Nail, Percutaneous Compression Plate (PCCP) and Femoral Head Replacement (FHR) Treatment on Senile Unstable Intertrochanteric Fractures. J Invest Surg, 2017. [Epub ahead of print].
13. Mingo-Robinet J, Torres-Torres M, Martínez-Cervell C, et al. Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases. J Orthop Trauma, 2015, 29(3): e85-90.
14. Yang JC, Chen HC, Lai YS. Measurement of Tip Apex Distance and Migration of Lag Screws and Novel Blade Screw Used for the Fixation of Intertrochanteric Fractures. PLoS One, 2017, 12(1): e0170048.
15. 陈太勇, 李开南, 汪学军, 等. Gamma钉内固定翻修原因及其疗效. 中国修复重建外科杂志, 2010, 24(1): 78-81.
16. Serrano R, Blair JA, Watson DT, et al. Cephalomedullary nail fixation Of intertrochanteric fractures: are two proximal screws better than one? J Orthop Trauma, 2017, 31(11): 577-582.
17. Kuzyk PR, Shah S, Zdero R, et al. A biomechanical comparison of static versus dynamic lag screw modes for cephalomedullary nails used to fix unstable peritrochanteric fractures. J Trauma Acute Care Surg, 2012, 72(2): E65-70.
18. Born CT, Karich B, Bauer C, et al. Hip screw migration testing: first results for hip screws and helical blades utilizing a new oscillating test method. J Orthop Res, 2011, 29(5): 760-766.
19. 江伟, 刘跃洪, 杨灵, 等. 股骨近端锁定钢板与Gamma3治疗稳定型股骨转子间骨折的生物力学比较研究. 中国修复重建外科杂志, 2014, 28(9): 1096-1099.

Chinese Journal of Reparative and Reconstructive Surgery

A clinical study on the relationship of the tail femur distance and the lag screw migration or cutting-out after the third generation of Gamma nail fixation of intertrochanteric fracture

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