The Failure Incidence of Trochanteric Fracture Fixation Using Gamma Nail or PFNA

Abstract

Aim: The importance of trochanteric fractures treatment consists in a relatively high frequency, especially in elderly patients. There is no “gold standard” implant for treating this type of fracture and various complications might occur in any particular case. The aim of this study was to evaluate the rates of implant related complications in patients treated for trochanteric fractures using two types of implants (Gamma 3® and PFNA®). The secondary objective was to assess the possible correlation between complication rates and technical parameters of insertion. Methods: Patients who met inclusion criteria were selected retrospectively between September 2018 and December 2020. Results: Ninety-five percent of patients were treated using a Gamma 3® nail while only 5% of them were treated using a PFNA® implant. Following AO classification, 60% of the patients presented an A1.3 fracture type and 29% presented an A1.2 fracture type. The global complication rate was 12.33% while specific incidence for each category of complications assessed in this group was as follows: 7.67% lateral protrusion of the lag screw, 3.67% cut-out, 0.67% impossibility of distal locking and 0.33% migration of distal locking screw. A significant difference p=0.018 was found between postoperative neck-shaft angles of the two groups of patients treated with the two types of implants. Conclusion: Use of Gamma 3® nails in trochanteric fractures obtains a degree of reduction closer to the physiological neck-shaft angle compared to the PFNA® implant. The most frequent complication type in our group was lateral protrusion of the lag screw followed by cut-out.