COMPARATIVE-STUDY OF GAMMA-NAIL AND NAIL, BLADE OR SCREW PLATES FOR SUB-TROCHANTERIC FRACTURES TREATMENT

Purpose of the study Treatment and outcome of sub-trochanteric fractur es are at the origin of many problems. The aim of this study was to ev aluate the superiority of the ''Gamma Nail''. Material and methods Two homogenous groups of patients were studied. Each group had 40 patient s. The osteosynthesis performed in the first group (Group I) was an '' angular'' type with lateral cortical support (Nail plate, blade plate, dynamic screw), The second group (Group II) received the ''Gamma Nail '' implant. The 4 criteria employed to compare the 2 groups were: oper atory (duration, blood loss, support-free walking); clinical (walking, pain, anatomy); radiological (reduction and healing); and finally com plications and failures. Results The average operative duration in gro up I was 3 hrs vs 1 hr in group II. 90 per cent of group I received tr ansfusions with 3 bloods units vs 40 per cent of group II, received 1 blood unit. Support-free walking was authorized 3 months later in grou p I, and immediately in group II. The results were identical for clini cal criteria. The average time for radiological bone healing was 3.5 m onths in group I and 2 months in Group II. 12 complications occured in group I and 3 in group Il. 7 cases of dismantling, 4 non unions and 1 serious deep infection in Group I. In group II: 2 cases of dismantlin g and a diaphysis fracture beneath the nail. These complications were found in the beginning of our experience with the Gamma Nail. Discussi on 30 per cent of patients in Group I were affected by complications v s 7.5 per cent in group II (with p = 0.01). The duration of surgery, b lood loss, and support-free walking delay demonstrated the superiority of the Gamma nail technique. Conclusion This study confirms the super iority of the Gamma nail for the treatment of sub-trochanteric fractur es.