title: Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail.
abstract: 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.
authors.affiliation: Department of Traumatology, University Hospital of Rotterdam, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
authors.forename: E W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: R M
authors.initials: RM
authors.lastname: Castelein
authors.forename: F H W M
authors.initials: FH
authors.lastname: van der Heijden
authors.forename: P T
authors.initials: PT
authors.lastname: den Hoed
authors.forename: A J H
authors.initials: AJ
authors.lastname: Kerver
authors.forename: A B
authors.initials: AB
authors.lastname: van Vugt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome