Gamma 3 nails combined with hollow compression screw fixation for intertrochanteric fracture of risky external wall type

Objective To evaluate Gamma 3 nails combined with hollow compression screw fixation in the treatment of intertrochanteric fracture of risky external wall type. Methods From November 2015 to December 2017, 60 patients with intertrochanteric fracture of risky external wall type were treated at Department of Orthopaedic Surgery, Wuhan Fourth Hospital. Of them, 27 ones, 15 males and 12 females with an age of 57.5 years±16.2 years (group A), were fixated with Gamma 3 nails and hollow compression screws, including 14 cases of AO type of 31-A2.2 and 13 cases of AO type of 31-A2.3. The other 33 patients, 18 males and 15 females with an age of 59.3 years±15.1 years (group B), were fixated with Gamma 3 nails alone, including 17 cases of AO type of 31-A2.2 and 16 cases of AO type of 31-A2.3. The 2 groups were compared in terms of operation time, hospitalization time, intraoperative blood loss, weight-bearing time, fracture healing time, complications and Harris hip scores at the final follow-up. Results The 2 groups were comparable due to insignificant differences between them in preoperative general data (P>0.05). The 60 patients obtained an average follow-up of 22.6 months (from 12 to 36 months). There were no statistically significant differences in operation time, intraoperative blood loss or hospital stay between the 2 groups (P>0.05). Group A had a significantly lower incidence of external wall redisplacement [7.4% (2/27)], significantly shorter weight-bearing time(5.4 weeks±1.0 weeks) and fracture healing time(18.3 weeks±3.9 weeks), and significantly higher Harris hip scores at the final follow-up (89.3±7.1) than group B did [24.2% (8/33), 7.4 weeks±1.3 weeks, 21.7 weeks±5.6 weeks and 79.5±8.3, respectively] (all P< 0.05). Follow-ups revealed no complications like femoral head cutting, implant breakage, deep vein thrombosis of lower limb, fat embolism, hip varus deformity or nail breakage in either group. Conclusion In the treatment of intertrochanteric fracture of risky external wall type, compared with Gamma 3 nails alone, Gamma 3 nails combined with hollow compression screw fixation can avoid external wall displacement or fixation failure after external medullary fixation or intramedullary fixation alone but does not increase operation time or intraoperative blood loss, leading to better functional recovery. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails