AO/OTA 31-A2 Fractures: #Long or Short Gamma Nail? by R Luque in BJSTR
Abstract
Introduction: The Gamma 3 nail is widely used for AO31A1-3 fractures. The aim of this study was to compare outcomes in patients with
31A2 fractures treated with two lengths of Gamma3 nail.
Material: A prospective study of 104 non-pathological 31A2
fractures treated January 2012-January 2014. 14 patients were eliminated
due to inadequate follow up. Mean follow-up was 18 months (range 12-36).
Average age was 81 years (range 50-99), 78% of the patients
were female. We studied two groups: Long Gamma3 Nail (LGN) and Short Gamma3 Nail (SGN). Preoperative variables included: age, medical
pathologies, gait, anesthetic risk, associated fractures, hemoglobin and
hematocrit values. Postoperatively, we evaluated: functional and
radiographic results, quality of life, hemoglobin concentration,
hematocrit, transfusion, gait and pain. Intraoperative and postoperative
complications were recorded: malunion, nonunion, infection rates,
cut-outs and periprosthetic fractures.
Results: We obtained a correct reduction in 73% of cases. We
found two intraoperative complications (greater trochanteric fractures)
in
two LGN cases. 38% of the patients with LGN presented nail tip impaction
upon the distal anterior femoral cortex, associated with anterior knee
pain. Blood loss was statistically different between groups but neither
clinical outcomes nor quality of life presented any differences.
Conclusion: Our results with these two sizes of the Gamma3
Nail in 31A2 fractures showed no overall differences in clinical
outcomes
and complication rates. Despite this, the LGN presented a statistically
significant higher decrease of the postoperative hematocrit and more
transfused blood concentrates. We therefore recommend the use of locked
SGN to treat the 31A2 fractures.
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