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Re: Severely comminuted Trochenteric #
Alexander Chelnokov 29 Январь 2006, 00:18
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GT> Whether one uses the DCS or a proximal femoral nail, the entry site for the
GT> lag screw is fractured so the lateral side hold of the screw is poor.
For Gamma it means nothing.
GT> I would still use the DCS.
It is much more demanding surgery than closed nailing through 1-2 cm incisions.
GT> Reason: familiarity with the device! But certainly the nail would
GT> be equally good (or bad!)
Nail would be definitely better - small wound, safe immediate weight-bearing...
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Re: Severely comminuted Trochenteric #
Отправитель: George Thomas 29 Январь 2006, 00:23
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Where is the proof that the nail permits earlier weight bearing. About the small incision, I agree.
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Re: Severely comminuted Trochenteric #
Отправитель: Alexander Chelnokov 29 Январь 2006, 00:24
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Gamma, PFN and relative nails were developed for that, i.e. immediate weight-bearing in fractures of proximal femur in elderly with osteoporosis.
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Re: Severely comminuted Trochenteric #
Отправитель: George Thomas 29 Январь 2006, 00:30
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That is what the manufacturers say, but is it the fact? No offence intended, but are there any studies to show that this is really true?
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Re: Severely comminuted Trochenteric #
Отправитель: Alexander Chelnokov 29 Январь 2006, 00:35
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GT> That is what the manufacturers say, but is it the fact? No offence
GT> intended, but are there any studies to show that this is really true?
Our current practice daily confirms that. Though of course many studies do. Some citations:
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Pelet S, Arlettaz Y, Chevalley F. Osteosynthesis of per- and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study. Swiss Surg. 2001;7(3):126-33
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CONCLUSION: We prefer Gamma nail in per- and subtrochanteric femoral fractures management, it allows early and fast weight-bearing and fracture healing is acquired in all cases.
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Sehat K, Baker RP, Pattison G, Price R, Harries WJ, Chesser TJ. The use of the long gamma nail in proximal femoral fractures. Injury. 2005
Nov;36(11):1350-4.
[...] The long gamma nail allowed early weight bearing...
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Moholkar K, Mohan R, Grigoris P. The Long Gamma Nail for stabilisation of existing and impending pathological fractures of the femur: an analysis of 48 cases. Acta Orthop Belg. 2004 Oct;70(5):429-34.
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The Long Gamma nail offers the advantage of a technically less demanding percutaneous insertion through the tip of the greater trochanter, secure proximal femoral fixation and the ability to allow immediate or early weight-bearing ambulation...
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