Abstract
Introduction: The main problem using first generation Gamma-nail in the treatment of intertrochanteric fractures has been a high frequency of intra- and postoperative femoral fractures. The TGN was thought to represent an improvement in design and potentially a less invasive treatment.
Material and methods: 146 fractures were randomised prospectively to either DHS or TGN. The 2 groups were comparable regarding age, gender and fracture type (AO). Follow-up was carried out after 4 and 12 months.
Results: Average operation time in the TGN group was 63 min (SD=30min) and 48 min (SD=23) in the DHS group (p=0.0016). There was no difference in intra-operative blood loss, need for blood transfusion, length of hospital stay or mortality. Two femoral fractures occurred postoperatively in the TGN group. At follow-up 12 patients in the TGN and 6 patients in the DHS group had had a reoperation (p> 0.05). Six reoperations in the TGN group and 3 in the DHS group resulted in preservation of the hip joint. The remaining patients had an arthroplasty or a Girdlestone resection. Poor reduction and/or positioning of the implant was significantly correlated to the risk of reoperation (p< 0.001). Specific technical errors could be identified among 3 fractures in the TGN group leading to reoperation. Any correlation between fracture type and reoperation could not be demonstrated.
Conclusion: In this study operation time was significantly longer in the TGN group. Among other variables no significant differences could be demonstrated. In our department, with a high number of residents performing these operations, the DHS will continue to be the standard implant. Whether the TGN has a place in a subgroup of intertrochanteric fractures, operated by specialized surgeons, needs further investigation.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
