Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail? |
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| Institution: | 1. Academic Department of Trauma and Orthopaedics, Floor A, Clarendon Wing, LGI, University of Leeds, Leeds, UK;2. NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK;1. Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK;2. Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, UK;1. Department of Surgery, Nassau University Medical Center, East Meadow, NY 11554, USA;2. Division of Trauma, Kings County Hospital Medical Center, Brooklyn, NY 11203, USA;3. Department of Family Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA;4. Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA;1. Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland;2. Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland;3. Division of Anatomy, University of Geneva Medical Center, Geneva, Switzerland;4. Faculté de Médecine, University of Geneva Medical Center, Geneva, Switzerland |
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| Abstract: | IntroductionPoor bone quality and unstable fractures increase the cut-out rate in implants with gliding lag screws. The U-Blade (RC) lag screw for the Gamma3® nail was introduced to provide monoaxial rotational stability of the femoral head and neck fragment. The purpose of this study was to evaluate whether the use of the U-Blade (RC) lag screw is associated with reduced cut-out in patients with OTA/AO 31A1-3 fractures.Material & methodsBetween 2009 and 2014, 751 patients with OTA/AO 31A1-3 fractures were treated with a Gamma3® nail at our institution. Out of this sample 199 patients were treated with U-blade (RC) lag screws. A total of 135 patients (117 female, 18 male) with standard lag screw (treatment group A) were matched equally regarding age (±4 years) sex, fracture type and location to 135 patients with U-blade (RC) lag screw (treatment group B). Within a mean follow up of 9.2 months (range 6–18 months) we assessed the cut-out rate, the calTAD, lag screw migration, the Parker's mobility score and the Parker’s ratio at postoperatively, six and 12 months following surgery. Furthermore we recorded all complications, ASA-Score, hospital stay and duration of surgery retrospectively.ResultsThe most common fracture among group B with a cut-out of the lag screw were AO/OTA 2.3 and 3.2 fractures whereas in group A cut-out was most commonly seen in AO/OTA 2.1, 2.2 and 2.3 fractures, there was no significant reduction of the cut-out rate in group B 2.2% (n = 3) compared to group A 3.7% (n = 5). The duration of surgery was significantly shorter in group A (p < 0.05). There was no significant difference in lag screw placement, the Parker’s ratio and mobilization.ConclusionIn our study the U-Blade (RC) lag screw did not reduce the cut-out in treatment of OTA/AO 31A1-3 fractures at all. Considering the longer duration of surgery and the higher costs of the U-Blade (RC) lag screw, our results do not justify its use. However, further prospective randomized studies will be necessary. |
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| Keywords: | U-Blade (RC) lag screw Gamma3 nail AO/OTA 31 A1-3 femur fractures Cut-out |
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