Summary
Background: Previous studies comparing the management of proximal femoral fractures by Gamma nail (GN) and Dynamic Hip Screw (DHS) with the purpose to evaluate and correlate the results of the 2 implants yielded conflicting results.
Methods: We prospectively studied 120 patients with special regard to differences within the first 6 months after pertrochanteric femoral fractures according to the AO/ASIF Classification 31-A.1-A.3, and randomly allocated them to either GN or DHS. Intra- and postoperative blood loss, operating time, mobility at 6 months (as a general indicator of postoperative complications), and limb length discrepancy were statistically analyzed.
Results: None of the studied issues showed significant inter group differences. The follow-up percentage was 97%.
Conclusions: The results lend support to the empirical practice of using the DHS as a sound, lower-cost option for stable, proximal femoral fractures, while for unstable fractures, the superior biomechanics of the GN are relied upon.
Zusammenfassung
Grundlagen: Frühere Vergleichsstudien über die Versorgung proximaler Femurfrakturen mittels Gamma-Nagel (GN) oder Dynamischer Hüftsschraube (DHS) haben insgesamt widersprüchliche Ergebnisse gezeigt.
Methodik: In einer prospektiv randomisierten Studie untersuchten wir 120 Patienten mit pertrochanteren Femurfrakturen der Klassifikation AO 31-A.1-A.3. Spezielles Augenmerk wurde auf die Ergebnisse innerhalb der ersten 6 postoperativen Monate gerichtet. Die statistische Analyse betraf folgende Kriterien: intra-und postoperativer Blutverlust; Operationsdauer; Mobilität nach 6 Monaten (als genereller Indikator für postoperative Komplikationen); Beinlängendifferenz.
Ergebnisse: Bezüglich der untersuchten Kriterien ergaben sich keinerlei statistisch signifikante Unterschiede. 97% der Patienten konnten nachuntersucht werden.
Schlußfolgerungen: Die DHS wird, vor allem aus Kostengründen, für die Versorgung stabiler proximaler Femurfrakturen empfohlen. Bei den instabilen Frakturen verwenden wir jedoch, aufgrund seiner in biomechanischen Studien nachgewiesenen Vorteile weiterhin den Gamma-Nagel.
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Kukla, C., Heinz, T., Berger, G. et al. Gamma nail vs. dynamic hip screw in 120 patients over 60 years — A randomized trial. Acta Chir Austriaca 29, 290–293 (1997). https://doi.org/10.1007/BF02621324
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DOI: https://doi.org/10.1007/BF02621324