$Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails$
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Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails

Abstract Background Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is...

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Autores principales:	Carlos Hernández-Pascual, José Ángel Santos-Sánchez, Juan Manuel García-González, Carlos Fernando Silva-Viamonte, Carmen Pablos-Hernández, Luis Ramos-Pascua, José Antonio Mirón-Canelo
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Intertrochanteric fracture Gamma3 Distal locking Consolidation Mechanical complications Cut-out Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/a5d3636a268042878d099c1e66897c65
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spelling	oai:doaj.org-article:a5d3636a268042878d099c1e66897c652021-11-28T12:30:42ZLong-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails10.1186/s10195-021-00609-41590-99211590-9999https://doaj.org/article/a5d3636a268042878d099c1e66897c652021-11-01T00:00:00Zhttps://doi.org/10.1186/s10195-021-00609-4https://doaj.org/toc/1590-9921https://doaj.org/toc/1590-9999Abstract Background Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the “orthopaedic school”. Materials and methods This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. Results Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. Conclusions Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5–6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. Level of evidence Therapeutic study, level 2b.Carlos Hernández-PascualJosé Ángel Santos-SánchezJuan Manuel García-GonzálezCarlos Fernando Silva-ViamonteCarmen Pablos-HernándezLuis Ramos-PascuaJosé Antonio Mirón-CaneloSpringerOpenarticleIntertrochanteric fractureGamma3Distal lockingConsolidationMechanical complicationsCut-outOrthopedic surgeryRD701-811ENJournal of Orthopaedics and Traumatology, Vol 22, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Intertrochanteric fracture Gamma3 Distal locking Consolidation Mechanical complications Cut-out Orthopedic surgery RD701-811
spellingShingle	Intertrochanteric fracture Gamma3 Distal locking Consolidation Mechanical complications Cut-out Orthopedic surgery RD701-811 Carlos Hernández-Pascual José Ángel Santos-Sánchez Juan Manuel García-González Carlos Fernando Silva-Viamonte Carmen Pablos-Hernández Luis Ramos-Pascua José Antonio Mirón-Canelo Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails
description	Abstract Background Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the “orthopaedic school”. Materials and methods This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. Results Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. Conclusions Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5–6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. Level of evidence Therapeutic study, level 2b.
format	article
author	Carlos Hernández-Pascual José Ángel Santos-Sánchez Juan Manuel García-González Carlos Fernando Silva-Viamonte Carmen Pablos-Hernández Luis Ramos-Pascua José Antonio Mirón-Canelo
author_facet	Carlos Hernández-Pascual José Ángel Santos-Sánchez Juan Manuel García-González Carlos Fernando Silva-Viamonte Carmen Pablos-Hernández Luis Ramos-Pascua José Antonio Mirón-Canelo
author_sort	Carlos Hernández-Pascual
title	Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails
title_short	Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails
title_full	Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails
title_fullStr	Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails
title_full_unstemmed	Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails
title_sort	long-term outcomes of distal locking in extracapsular fractures treated with trochanteric gamma3 nails
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/a5d3636a268042878d099c1e66897c65
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Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails

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