Pertrochanteric fractures pfs frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. Gamma3 nail long this nail incorporates several important mechanical design features. The gamma nail is the latest advance in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures. Gamma is a comprehensive intramedullary nailing system for the treatment of a wide range of proximal femur fractures as well as associated femoral shaft. Original article a comparative study of long thirdgeneration. The nail is unslotted and cannulated for guidewirecontrolled insertion. It has been evolved, from the kuntscher y nail 4, by grosse strasbourg, in conjunction with howmedica. Its design is based on kuntschers ynail and locking intramedullary im nails. Although femoral neck screws are available in various diameters, lengths and angles, the standard nail is 20 cm long. The gamma nail, a combination of advantages of the sliding screw with the intramedullary nail, represents an efficient technique in the management of these fractures. To facilitate conformity with the human anatomy, the long nail is supplied in a. Pdf the gamma nail and proximal femoral locking plate pflp are both used for fractures.
A controlled study was performed to determine the optimal implant. A comparison of the long gamma nail with the sliding hip screw for the treatment of aoota 31a2 fractures of the proximal part of the femur. Therefore, if no bone consolidation occurs or if consolidation is not sufficient, the system may break. A prospective randomized study was used to compare the ambi hip screw and the gamma nail for the treatment of 69 patients over the age of 50 years. A range of three different neckshaft angles are available for lag screw entry to accommodate variations in femoral neck anatomy. The evolution of the successful trochanteric and long gamma nails as well as the small stature versions followed strictly a step by step improvement based on the clinical. We present the first reported case of breakage of a third generation gamma nail that was not used to treat a pathological fracture. See instructions to authors for a complete description. If a sideplate system is used, the femur shaft may be weakened through a high number of locking screws. The nail is secured with a screw lower down the femur. Intramedullary nailing for pertrochanteric fractures of. Internal fixation is an operation in orthopedics that.
The medical implant is mainly fabricated using stainless steel and titanium alloys for strength and the plastic coating that is done on it acts as an artificial cartilage. Pfna nail optimal fit the anatomical design guarantees an optimal. This is the third generation of intramedullary short and long gamma fixation nails. Mar 28, 2011 this 3d medical animation features a dramatic surgical overview during the operative placement of an intramedullary nail into the right leg to secure a comminuted femur fracture.
The gamma3 locking nail system is based on more than 16 years of gamma nail experience. When compared with the long gamma nail, the sliding hip screw should remain the gold standard for the treatment of aoota 31a2 fractures of the proximal part of the femur because it is associated with similar outcomes with less expense. This paper reports the results from the firstever series of 121 patients operated between 1988 and 1990. Pdf gamma nails have been used extensively for the treatment of proximal femoral fractures. It usually requires surgery and months of physical therapy. The advent of intramedullary nails for recon struction has provided a useful tool in the treatment of pathological fractures of the femur. Original study the long gamma nail for stabilisation of existing. The t2 im nailing platform offers a combination of innovation, simplicity and versatility that is designed to suit your various needs. Nail length selection with the tip of the ball nose guide wire at the level of the desired depth of nail insertion, slide or snap the nail length.
The long gamma locking femoral cephalomedullary nail stryker trauma, geneva, switzerland was introduced in 1993. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. A femur fracture is typically sustained from highenergy impact such as motor vehicle collisions, falls from playground equipment, falls from furniture or resulting from a twisting mechanism. Stryker gamma nail to treat a hip intertrochanteric fracture. Gamma3 nail 180 the anatomical shape of the nail is universal for all indications involving the treatment of trochanteric fractures. Gamma3 nail 180 all nails use the same lag screws, set screw, distal locking screws and end caps see fig. Proximal femoral nail antirotation surgical technique pfna. Trochanteric gamma nail and compression hip screw for trochanteric fractures. Nov 28, 2018 however, long gamma nailing has a wellrecognized risk of anterior cortical abutment or perforation due to anatomical variations in the anterior bow of the femur and poor nail entry point.
Femoral universal femoral universal nailing system options. The gamma3 locking nail system was developed based on more than 15 years of gamma nail experience. The aim of this study is to evaluate the management of pertrochanteric fractures of the femur using gamma nail asia pacific ap. However, in four cases fracture of the femur occurred close to the gamma nail, requiring further major surgery. The gamma nail ensures immediate stability permitting early mobilization and weightbearing, limited only by the patients general condition. The gamma3 locking nail system was developed based on more than. Use of the gamma nail in the treatment of fractures of the. The evolution of the successful trochanteric and long gamma nails as well as. Gamma3 long nail is intended for fixation of stable and unstable femoral fractures occurring from the base of the femoral neck extending distally to a point approximately 10cm proximal to the intracondylar notch including fractures of the basilar neck, intertrochanteric fractures, peritrochanteric fractures, subtrochanteric fractures and femoral shaft fractures. Femoral universal nails are available in 1 mm increments from 9 mm to 15 mm diameters. Surgical technique product information mri information 78 tfn titanium trochanteric fixation nail system 2 biomechanical features 3 ao principles 6 indications 7 clinical cases 8 preoperative implant selection 9 open proximal femur 10 insert nail 17 proximal locking 21 distal locking short nails 35 surelock distal targeting device. Jul 24, 2018 the gamma nail and proximal femoral locking plate pflp are both used for fractures.
An intertrochanteric fracture is a common hip fracture that happens most often in older adults. The gamma 3 nail is widely used for ao31a fractures. Pertrochanteric fractures which involve trochanteric fractures with varying fracture geometry pose a significant challenge to the treating orthopedic surgeon. Do not engage in prolonged periods of standing or walking the first 710 days following surgery. Note as template magnification levels are set at 117%, all measurements are estimates of true size. The gamma nail combines the advantages of the two techniques most often used in the treatment of fractures of the proximal end of the femur. The use of the long gamma nail in proximal femoral fractures. Is there a standard rehabilitation protocol after femoral in. Dec 18, 2019 elos nail is a reliable device on a shortterm followup and represents an alternative choice to the gamma 3 nail, a wellknown and appreciated system for over 25 years. The stress in the calcar region which was the main loadbearing area of the intact femoral neck was decreased markedly in all of the models, especially in model fixed with gamma nail. The displacement of femurs fixed by gamma nail showed smaller displacement. Original article biomechanical comparison of dynamic hip.
The nail design has been well proven in over 450 000 cases performed with the pfn and pfna. Trochanteric and long gamma nails as well as the asia pacific and. Gamma3 nail 170 and 180 the anatomical shape of the nail is universal for all indications involving the treatment of trochanteric fractures. Barton tm, gleeson r, topliss c, greenwood r, harries wj, chesser tj. Long nail all nails use the same lag screws, set screw, distal locking screws and end caps see fig. Controlled study on gamma nail and proximal femoral locking. The evolution of the successful trochanteric and long gamma nails as well as the asia pacific and japanese versions followed strictly a stepbystep. Results of its precursor, the standard gamma nail have previously been documented, 11 however, the long gamma nail lgn exhibits different mechanical characteristics and has different indications, therefore it should be considered as a different implant. The nail is cannulated for guidewirecontrolled insertion and. Nail breakage at the level of the aperture of the lag. Nail dynamization for delayed union and nonunion in femur and tibia fractures.
A comparison of the long gamma nail with the sliding hip. Patient sustained a fielding type ii a subtrochanteric non pathological fracture of her left femur which was which was fixed. Its efficacy in an australasian setting has not been documented. Retrograde femoral nailing has expanded the use of intramedullary nails 1, 2. The aim of postoperative care must be to ensure the promotion of bone consolidation. Sridhar durbhakula narrates a surgical procedures using trochanteric gamma nail and compression hip. The gamma nail has been introduced as an advance over the ambi hip screw in intertrochanteric femoral fractures. A comparative study of long thirdgeneration gamma nail and long proximal femoral nail antirotation in the treatment of subtrochanteric femoral fracture maofeng gao, ruofu zhu, weidong shi, huilin yang orthopaedic institute, the first affiliated hospital of soochow university, shizi 188 st. Pdf fixation of intertrochanteric fractures of the femur. Gamma nail in the treatment of closed trochanteric fractures. Stable fixation of these fractures can be obtained using a special intramedullary nail known as the gamma nail.
Nail dynamization for delayed union and nonunion in femur. Pdf controlled study on gamma nail and proximal femoral locking. A lag screw is placed through the nail into the femoral head to secure the nail in place proximally and help control the different segments of the. Role of gamma nail in management of pertrochanteric fractures. This is the third generation of gamma intramedullary short and long fixation nails. Four months later she developed pain in her left hip area and check radiographs confirmed a failure of the gamma nail through the insertion. A randomized prospective comparison of the gamma nail and the dynamic hip screw. From january 2006 to december 2008 we conducted a prospective singlecenter study including 84 consecutive patients with pertrochanteric femoral fractures treated with either a gamma 3 nail gn strykerhowmedica, rutherford, nj the latest evolution of gamma device or a long gamma 3 nail lgn dyax. Current evidence suggests that a significant cohort of femur fracture patients managed with an intramedullary im nail will ultimately possess residual impairments and disability up to 3 years after surgery.
Gamma nail in both types of fractures shared the smaller displacement. Trochanteric and long gamma nails as well as the asia pacific and japanese. Stryker gamma nail to treat a hip intertrochanteric fracture youtube. Quality of life after pertrochanteric femoral fractures. The gamma3 locking nail system is based on more than 20 years of gamma nail experience. Sridhar durbhakula narrates a surgical procedures using trochanteric gamma nail and compression hip screw for trochanteric fractures. The nail features a small proximal section that is designed to minimize the amount of bone that must be removed for nail insertion. Pdf trochanteric gamma nail and compression hip screw. The evolution of the successful trochanteric and long gamma nails as well as the asia pacific and japanese versions followed strictly a step by.
Surgical technique implant selection the trigen tan 71180884 and trigen fan 71180497 radiographic templates may be used to assist with preoperative implant selection. The nail is cannulated for guidewirecontrolled insertion. The gamma nail is designed for temporary implantation until the bone consolidation occurs. Overcoming anterior breaches in the distal femur during long. You have had an intramedullary im nail or gamma nail which involves placing a. Nail length, locking screw length and nail cap size may be determined. Surgical principles fractures of the neck of the femur and of the trochanteric region are typical injuries of the elderly. An 83yearold woman with an unstable trochanteric fracture of the femur was treated using a third generation gamma nail. Gamma3 nail is intended for fixation of stable and unstable femoral fractures. Complicated multiple trauma injuries, associated pelvic and acetabular fractures, ipsilateral femoral shaft fractures, supracondylar and intercondylar fractures, may be better. Intramedullary nailing of right femur fracture youtube. A series of 224 fractures of the proximal femur in which this nail was used is reported.
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