Abstract
Various intramedullary nail systems have been established for the treatment of per- and subtrochanteric femoral fractures. This study focused mainly on the advantages and disadvantages of implementing a new intramedullary nail system named the PLATON nail. One hundred and thirty patients who had per- and subtrochanteric femoral fractures were treated using the intramedullary PLATON nail over the period from September 2001 until May 2003. The median age of these patients was 76 (range: 39-98) years with a predominance of female patients (3 : 1). The classification of the fractures was determined with regard to Evans and the AO guidelines. Patient compliance was recorded, as well as clinical and radiographic examinations for each patient. The 130 operations were conducted by 28 surgeons. The mean time of surgery was 54 minutes. A closed reduction of the fracture preceded the locking nail implantation in 94 % of the cases. The insertion of the nail was found to be easy by 93 % of the surgeons. A lateral movement of the femoral lag screw due to displacement was seen in 5 cases. Infection and haematoma were observed in 5 patients. Compared to other similar implants, the cut-out rates, secondary fractures, implant failures and the need for revision were lower. On the other hand, the incidences of infection, haematoma and irritation are comparable to other implants. While the differences between the PLATON nail and other types of systems were moderate in many respects, a visible reduction of cut-out and secondary fractures were indicated by this study.
Key words
Trochanteric fracture - subtrochanteric fracture - femur fracture - PLATON nail - intramedullary nail
References
-
1
Adams C I, Robinson C M, Court-Brown C M, McQueen M M.
Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur.
J Orthop Trauma.
2001;
15
394-400
-
2
Albareda J, Laderiga A, Palanca D. et al .
Complications and technical problems with the gamma nail.
Int Orthopaed.
1996;
20
47-50
-
3
Andreß H J, Forkel H, Grubwinkel M, Landes J, Piltz S, Hertlein H, Lob G.
Versorgung der per- bis subtrochantären Femurfraktur durch Gammanagel und modulare Hüftprothese.
Unfallchirurg.
2000;
103
444-451
-
4
Baumgaertner M R, Curtin S L, Lindskog D M.
Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures.
Clin Orthop.
1998;
348
87-94
-
5
Bridle S H, Patel A D, Bircher M. et al .
Fixation of intertrochanteric fractures of the femur. A randomized prospective comparison of the Gamma nail and the dynamic hip screw.
J Bone Joint Surg [Br].
1991;
73
330-334
-
6
Butt M S, Kriklers S J, Nafie S, Ali M S.
Comparison of dynamic hip screw and gamma-nail.
Injury.
1995;
26
615-618
-
7
Chi-Chuan W, Chun-Hsiung S, Ming-Yih L, Ching-Lung T.
Biomechanical analysis of location of lag screw of a dynamic hip screw in treatment of unstable intertrochanteric fracture.
J Trauma.
1996;
41
699-702
-
8
Friedl W.
Vergleichende Untersuchung der Gammanagel(G)- und Gleitnagel(GN)-Osteosynthese bei per- und subtrochantären Femurfrakturen.
Hefte Unfallchir.
1996;
262
4-8
-
9
Fritz T, Hiersemann K, Krieglstein C, Friedl W.
Prospective randomized comparison of Gliding Nail and Gamma Nail in the therapy of trochanteric fractures.
Arch Orthop Trauma Surg.
1999;
119
1-6
-
10
Fritz T, Weiss C, Krieglstein C, Quentmeier A.
The classic nail in the therapy of trochanteric fractures: A prospective, controlled study.
Arch Orthop Trauma Surg.
1999;
119
308-314
-
11
Gaebler C, Stanzl-Tschegg S, Tschegg E K, Kukla C, Menth-Chiari W A, Wozasek G E, Heinz T.
Implant failure of the gamma nail.
Int J Care Injur.
1999;
30
91-99
-
12
Guyer P, Landholt M, Keller H, Eberle C.
Der Gammanagel bei per- und intertrochantären Femurfrakturen: Alternative oder Ergänzung zur DHS.
Akt Traumatol.
1991;
21
242-249
-
13
Guyer P, Landolt M, Eberle C, Keller H.
The Gamma nail as a resilient alternative to the dynamic hip screw in unstable proximal femoral fractures in the elderly.
Helv Chir Acta.
1992;
58
697-703
-
14
Halder S C.
The gamma nail for peritrochanteric fractures.
J Bone Joint Surg [Br].
1992;
74
340-344
-
15
Hardy D CR, Descamps P Y, Krallis P, Fabeck L. et al .
Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures.
J Bone Joint Surg [Am].
1998;
80
618-630
-
16
Haynes R C, Poll R G, Miles A W, Weston R B.
Failure of femoral head fixation: a cadaveric analysis of lag screw cut out with the gamma locking nail and AO DHS.
Injury.
1997;
28
337-341
-
17
Heinz T, Vécsei V.
Komplikationen und Fehler bei der Anwendung des Gammanagels.
Chirurg.
1994;
65
943-952
-
18
Kaiser W, Burmeester J, Hausmann H, Guliemos V, Hatzel M, Merker S J.
Vergleichende Stabilitätsprüfung von DHS und Gamma-Nagel-Osteosynthesen bei instabilen pertrochanteren Femurosteotomien.
Langenbecks Arch Chir.
1997;
382
100-106
-
19
Leung K S, So W S, Shen W Y, Hui P W.
Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients.
J Bone Joint Surg [Br].
1992;
74
345-351
-
20
Lustenberger A, Ganz R.
Epidemiologie trochantärer Femurfrakturen über 2 Jahrzehnte (1972-1989).
Unfallchirurg.
1995;
98
278-282
-
21
Mahaisavariya B, Laupattarakasem W.
Craking of the femoral shaft by the Gamma nail.
Injury.
1992;
23
493-500
-
22
Parker M J.
Cutting out of the dynamic hip screw related to its position.
J Bone Joint Surg [Br].
1992;
74
625
-
23
Parker M J, Pryor G A.
Gamma nailing versus DHS for extracapsular femoral fractures: a meta-analysis of 10 randomised trials.
Int Orthop.
1996;
20
163-168
-
24
Rebuzzi E, Pannone A, Schiavetti S, Santoriello P, de Nicola U, Fancellu D, Caub P, Gulli S, Dordolin P, Maniscalco P, Morici F, Commessatti M, Pozzi-Mucelli M, Maiorana C S, Bassini F.
IMHS clinical experience in the treatment of peritrochanteric fractures. The results of a multicentric Italian study of 981 cases.
Injury.
2002;
33
407-412
-
25
Rosenblum S F, Zuckerman J D, Kummer F J. et al .
A biomechanical evaluation of the Gamma nail.
J Bone Joint Surg [Br].
1992;
74
352-357
-
26
Schmit-Neuerburg K P.
Versorgung per- und subtrochanterer Femurfrakturen mit Osteosynthesen und Endoprothesen.
Aktuel Chir.
1995;
30
2-8
-
27
Schumpelik W, Jantzen P M.
Die Versorgung der Frakturen im Trochanterbereich mit einer nichtsperrenden Laschenschraube.
Chirurg.
1953;
24
506-508
-
28
Shaw J A, Wilson S.
Internal fixation of proximal femur fractures: a biomechanical comparison of the Gamma locking nail and the omega compression hip screw.
Orthop Rev.
1993;
22
61-68
-
29
Simmermacher R KJ, Bosch A M, Van der Werken C.
The AO/ASIF proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures.
Injury.
1999;
30
327-332
-
30
Steindl A, Schörghuber L.
Frühergebnisse und Problemanalyse nach Versorgung per- und subtrochantärer Oberschenkelfrakturen mit Gleitnagel und PFN.
Osteosynthese International.
2000;
8
86-94
-
31
Traeger G, Schmid C, Zettl R, Schweiberer L, Nast-Kolb D.
Stable and unstable pertrochanteric femoral fractures. Differentiated indications for the dynamic hip screw.
Unfallchirurg.
2000;
103
741-748
-
32
Wagner R, Blattert T R, Weckbach A.
Problemlösung der extraartikulären, koxalen Femurfraktur durch das „Gleitschrauben-Nagel-Prinzip”. Ergebnisse zweier verschiedener Systeme.
Unfallchirurg.
1998;
101
894-900
-
33
Williams W W, Parker B C.
Complications associated with the use of the Gamma nail.
Injury.
1992;
23
291-292
Dr. med. Theodoros Pavlidis
Department of Trauma Surgery · Justus-Liebig-University
Rudolph-Buchheim-Straße 7
35385 Gießen
Germany
Phone: +49/6 41/9 94 46 01
Fax: +49/6 41/9 94 46 09
Email: Theodoros.Pavlidis@chiru.med.uni-giessen.de
