- Discussion:
- a type of intramedullary device (designed for
intertrochanteric and
subtrochanteric fractures) which
allows controled sliding of the femoral head screw within the IM nail glidign hole;
- advantages of IM device:
- IM nail with interlocking reconstruction screws has better biomechanical advantage than sliding
hip screw and plate (
forces acting on the hip joint);
-
unstable intertrochanteric fractures:
- standard placement of sliding screw and plates often causes excessive medialization and/or distraction
at the fracture site where as insertion of the sliding screw and plate at low angles (95 deg) will
avoid medialization (and distraction) but will not allow sliding;
- in contrast, a properly inserted IM hip screw will block medialization of the fracture, and yet will allow
controlled sliding at the fracture site;
- disadvantages of the IM device:
- thigh pain (attributed to use of 2 distal interlocking screws);
- need to obtain reduction prior to nail insertion;
- difficulty with optimizing placement of the femoral head screw,
- increased OR time;
-
outcomes:
- in the study by
Hardy et al 1988, the nail was associated with less sliding than seen w/ standard
compression hip screw devices and therefore was associated with less limb shortening;
- Technical Considerations:
-
surgical work up:
-
reduction:
- reduction must be achieved either by closed or open means prior to nail insertion;
- failure to achieve reduction prior to nail insertion will complicate the nail insertion (one fragment
may end up eccentrically opposed to the other) and will make judgement of the reduction on the
lateral view impossible (due to the nail and its targeting device);
- open reduction may initially be held with a single guide pin placed along the anterior margin of the fracture;
- far anterior insertion of the guide pin will not interfere with the nail insertion;
-
intramedullary nailing technique
-
reconstruction screw insertion in femoral head:
- same considerations for sliding hip screw;
Analysis of six hundred and twenty-two intertrochanteric hip fractures.
Use of an intramedullary hip screw compared with a compression hip screw with a plate for intertrochanteric fractures. A prospective randomized study of one hundred patients.
Fracture of the neck and intertrochanteric region of the femur in children.
External fixation of intertrochanteric fractures of the femur.
The Gamma nail for peritrochanteric fractures.
Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients.
A biomechanical evaluation of the Gamma nail.
Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation.
Intertrochanteric fractures of the femur in rheumatoid arthritis patients.
Closed retrograde intramedullary nailing of peritrochanteric fractures of the femur with a new nail.
Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw.
A prospective randomised comparison of the dynamic hip screw and the gamma locking nail.
Trochanteric fractures of the femur. A randomised prospective trial comparing the Jewett nail-plate with the dynamic hip screw.
Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail
Intertrochanteric femoral fractures. Mechanical failure after internal fixation.
Avascular necrosis of the femoral head after intertrochanteric fractures.
EJ Baizauli et al. Journal or Orthopedic Trauma. Vol 13. No 2. 1999. p 134.
Postoperative weight bearing after a fracture of the femoral neck or an intertrochanteric fracture. KJ Koval et al. JBJS. Vol 80-A. No 3. March 1998. p 352.
The Holland nail((R)): a universal implant for fractures of the proximal femur and the femoral shaft.
Cementless Calcar-Replacement Hemiarthroplasty Compared with Intramedullary Fixation of Unstable Intertrochanteric Fractures.
