240. TROCHANTERIC FRACTURES FIXED WITH A RECONSTRUCTION SCREW: RETROSPECTIVE COMPARISON OF THE GAMMA3™ AND THE PFN-A™ WITH ANALYSIS OF IMPLANT-SPECIFIC COMPLICATIONS

Abstract

Purpose of the study: The purpose of this work was to analyse the respective complications of nail fixations for trochanteric fractures. Since January 2005, we have used the Gamma3™ and the PFN-A™ in routine practice. These nails have evolved and we wanted to compare the latest generation models.

Material and methods: This was a prospective consecutive series of 426 files in a single centre (January 2005 to October 200) reviewed at mean 19 months (3–36 months). All patients with a fracture of the trochanter treated by osteosynthesis were included. Eight senior operators implanted Gamma3™ nails (4 operators) or PFN-A™ nails (4 operators). During this period, 236 Gamma3™ and 190 short PNF-A™ nails were implanted. The two cohorts were statistically comparable regarding: mean age, body weight, ASA score, preoperative autonomy, repair of fracture type.

Results: There was no significant difference between the two implants for: implant position (correct position for 80%), early mortality (5.5%), rate of sepsis (1.6%), which were comparable with the literature. In these two groups, the operative time was shorter than in the literature with an advantage for the PFN-A™ (40 min versus 35 min). Sliding was minimal (1.3% for Gamma3™ versus 1.1% for PFN-A™), as was revision (5.1% versus 4.7%). Conversely, the technical complications were implant dependent: defective automatic distal locking for the Gamma3™ (n=24, 10.2%) with fracture on nail for four patients, and protrusion of the cephalic blade for the PFN-A™ (n=11, 5.8%) due to insufficient impaction and to back glide after excessive distraction followed by impaction.

Discussion: There is a rich body of knowledge on the different nail and screw-plate models. Mean sliding is to the order of 4% and mean revision about 8–9%. We could not find a study comparing the new implant generations. These implants enable a reduction of the general complications for trochanteric surgery, but to ensure persistent results, care must be taken for the distal locking of the Gamma3™ and the intraoperative protrusion of the PFN-A™ blade.