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TREATMENT OUTCOMES OF CONCOMITANT IPSILATERAL NECK AND TROCHANTERIC FRACTURES USING GAMMA3 NAILS WITH U-BLADE LAG SCREWS
K HYUK SUNG, SO HAK CHUNG
Acta Orthopaedica et Traumatologica Turcica - 2024;58(4):209-214
Department of Orthopaedic Surgery, Kosin University College of Medicine, Busan, Korea

Objective: This study aimed to investigate the outcomes of Gamma3 nails fitted with U-blade lag screws in the management of combined neck and trochanter fracture of the femur. Methods: Two hundred-fifty patients with fractures in the proximal femur underwent treatment using Gamma3 nails integrated with U-blade lag screws from 2015 to 2022. Among these cases, 33 had combined neck and trochanteric fractures; 8 patients were excluded because of follow-up for <1 year. The remaining data of 25 patients (7 males and 18 females) were reviewed. Bone mineral density (BMD), body mass index (BMI), tipapex distance (TAD), extent of lag screw migration, femoral neckshaft angle, callus formation, fracture type, and treatment failure were analyzed. Results: The mean patient age was 76.3 (range, 61-91) years, and the mean follow-up duration was 17.3 (range, 12.5-57.3) months. The mean BMD T-scores for the spine and femoral neck were -2.3 1.0 and -2.8 0.7, respectively; 18 patients had T-scores ≤-2.5, indicating osteoporosis. The mean BMI was 23.2 3.8 kg/m2, and the mean operative time was 69.8 (range, 45-90) minutes. Twenty-one patients experienced injuries from slipping, 2 sustained injuries from falling, and 2 from car traffic accidents. The mean TAD was 21.6 5.9 mm, with 16 patients showing <25 mm. The mean extent of lag screw migration was 5.7 5.1 mm. The mean femoral neckshaft angle on plain radiographs was 125.1 8.6 degrees immediately postoperatively and 120.3 9.5 degrees at the final follow-up. During the follow-up period, the first callus formation was observed at 3.8 months (range, 1.4-7.3) on plain radiographs in the anteroposterior and axial views. Based on our fracture criteria, 4 patients had a two-part fracture type, 12 patients had three-part, and 9 patients had four-part. Out of 25 patients, 3 exhibited treatment failure. No significant differences were observed between the groups with and without bone union regard- ing age, BMD, BMI, operative time, TAD of the lag screw, extent of lag screw migration, and femoral neckshaft angle. Conclusion: The bone union was achieved in 88% of patients who underwent treatment utilizing the U-blade Gamma3 nail for concomi- tant ipsilateral neck and trochanteric fractures. Level of Evidence: Level IV, Therapeutic Study

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