Modified gamma nail for the treatment of peritrochanteric fractures

Hitesh, Gopalan (2006) Modified gamma nail for the treatment of peritrochanteric fractures. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Intertrochanteric fractures are one of the most devastating injuries in the elderly. The incidence of these fractures increase with advancing age. These patients are more limited to home ambulation and are dependent in basic and instrumental activities of daily living. There is an association between patients developing intertrochanteric fracture and previous humeral, vertebral and distal radius fracture. Various modalities of fixation are available for the treatment of intertrochanteric fractures. The sliding hip screw device has been used for more than a decade for the treatment of these fractures. Though Zickel introduced his nail long ago it was not a very popular fixation device due to higher incidence of complications. AIM: To assess the effectiveness of the Modified Gamma Nail for the treatment of peritrochanteric fractures. MATERIALS AND METHODS: At our institution we selected 18 cases of peritrochanteric fractures for this prospective study. All 18 cases were treated with the Modified Gamma nail (indigenous) of which 17 patients came for regular follow up and they were included in the study. The age group varied from a minimum of 35yrs to a maximum of 72 years, and average age was 54 years. The duration of the study was from June 2003 to May 2005. The mean follow up was 1and half years. Of the 17 patients 11 were males and 6 were females. Right side was involved in 9 cases and in 8 patients the left side was involved.12 patients were sedentary workers and 5 patients were manual labourers. RESULTS: Average operating time was 70.4 minutes for the patients treated with the Modified Gamma Nail. Blood loss varied from 100 to 150ml. The average blood loss was 122ml in those treated with the Modified Gamma nail. The mean usage of image intensifier was 118 seconds. Fourteen fractures healed at an average of 12 weeks postoperatively (range 9-19 weeks) of the index procedure. All the patients were ambulated early as early as 3 weeks with aids and at the end of 6 weeks all patients were allowed full weight bearing. The mean Harris Hip score at the end of 3 months was 79 and at the end of 6 months was 85. 1 patient required a cane during subsequent follow up. All the patients went back to their original work. None of the patients developed thigh pain. CONCLUSION: Intramedullary nailing with the Modified Gamma Nail has distinct advantages over DHS like shorter operating time and lesser blood loss for unstable Peritrochanteric fractures. Modified Gamma Nail- by decreasing the proximal diameter of the original Gamma Nail (15mm), is a suitable alternative for DHS in Indian patients Early mobilization and weight bearing is allowed in patients treated with Modified Gamma nailing thereby decreasing the incidence of bedsores, Uraemia and hypostatic pneumonia. The incidence of peroperative and postoperative femoral shaft fractures in Modified Gamma nailing can be reduced by good preoperative planning and correct technique, adequate reaming of the femoral canal, insertion of implant by hand and meticulous placement of distal locking screws Modified Gamma nailing is a significant advancement in the treatment of Peritrochanteric fractures which has the unique advantage of closed reduction, preservation of fracture hematoma, less tissue damage during surgery, early rehabilitation and early return to work.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Modified gamma nail ; peritrochanteric fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:07
Last Modified: 17 Sep 2017 02:11

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