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Journal of Bone and Joint Surgery - British Volume, Vol 86-B, Issue 1, 86-94.
doi: 10.1302/0301-620X.86B1.14455  
Copyright © 2004 by British Editorial Society of Bone and Joint Surgery
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Treatment of unstable trochanteric fractures

RANDOMISED COMPARISON OF THE GAMMA NAIL AND THE PROXIMAL FEMORAL NAIL

I. B. Schipper, MD, Trauma Surgeon1; E. W. Steyerberg, PhD2; R. M. Castelein, MD, PhD, Professor of Orthopaedic Surgery3; F. H. W. M. van der Heijden, MD, General Surgeon4; P. T. den Hoed, MD, General Surgeon5; A. J. H. Kerver, MD, General Surgeon6; and A. B. van Vugt, MD, PhD, Professor of Trauma Surgery1

1 Department of Traumatology, University Hospital of Rotterdam, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
2 Department of Public Health, Center for Clinical Decision Sciences, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
3 Department of Orthopeadics, University Hospital of Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
4 Department of Surgery, Onze Lieve Vrouwe Hospital, PO Box 95500, 1090 HM Amsterdam, The Netherlands.
5 Department of Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands.
6 Department of Surgery, St Franciscus Hospital, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.

Correspondence should be sent to Dr I. B. Schipper.

The proximal femoral nail (PFN) is a recently introduced intramedullary system, designed to improve treatment of unstable trochanteric fractures of the hip. In a multicentre prospective clinical study, the intra-operative use, complications and outcome of treatment using the PFN (n = 211) were compared with those using the gamma nail (GN) (n = 213).

The intra-operative blood loss was lower with the PFN (220 ml v 287 ml, p = 0.001). Post-operatively, more lateral protrusion of the hip screws of the PFN (7.6%) was documented, compared with the gamma nail (1.6%, p = 0.02). Most local complications were related to suboptimal reduction of the fracture and/or positioning of the implant. Functional outcome and consolidation were equal for both implants.

Generally, the results of treatment of unstable trochanteric fractures were comparable for the PFN and GN. The pitfalls and complications were similar, and mainly surgeon- or fracture-related, rather than implant-related.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General