title: Expandable proximal femoral nail versus gamma proximal femoral nail for the treatment of AO/OTA 31A1-3 fractures.
abstract: BACKGROUND
  The gamma-proximal femoral nail (GPFN) and the expandable proximal femoral nail (EPFN) are two commonly used intramedullary devices for the treatment of AO 31A1-3 proximal femur fractures. The aim of this study was to compare outcomes and complication rates in patients treated by both devices.
  
  
  METHODS
  A total of 299 patients (149 in the GPFN group and 150 in the EPFN group, average age 83.6 years) were treated for AO 31A1-3 proximal femur fractures in our institution between July 2008 and February 2013. Time from presentation to surgery, level of experience of the surgeon, operative time, amount of blood loss and number of blood transfusions were recorded. Postoperative radiological variables, including peg/screw location, tip to apex distance and orthopaedic complications, as, malunion, nonunion, surgical wound infection rates, cutouts, periprosthetic fractures and the incidence of non-orthopaedic complications. Functional results were estimated using the modified Harris Hip Score, and quality of life was queried by the SF-36 questionnaire.
  
  
  RESULTS
  The GPFN and the EPFN fixation methods were similar in terms of functional outcomes, complication rates and quality of life assessments. More patients (107 vs. 73) from the GPFN group were operated within 48 h from presentation (44.8 h vs. 49.9 h for the EPFN group, p=0.351), and their surgery duration and hospitalisation were significantly longer (18.5 days vs. 26 days, respectively, p<0.001). The GPFN patients were frequently operated by junior surgeons: 90% (135) while 50.6% (76) of the EPFN operations were performed by senior doctors. Other intraoperative measures were similar between groups. Cutout was the most common complication affecting 6.7% of the GPFN group and 3.3% of the EPFN group (p=0.182).
  
  
  CONCLUSIONS
  Good clinical outcomes and low complication rates in the GPFN and the EPFN groups indicate essentially equivalent safety and reliability on the part of both devices for the treatment of proximal femoral fractures.
authors.affiliation: Division of Orthopedic Surgery. Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: mt.drexler@gmail.com.
authors.forename: Drexler
authors.initials: D
authors.lastname: Michael
authors.affiliation: Division of Orthopedic Surgery. Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Warschawski
authors.initials: W
authors.lastname: Yaniv
authors.affiliation: Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Frenkel Rutenberg
authors.initials: FR
authors.lastname: Tal
authors.affiliation: Buffalo General Hospital, Department of Surgery, University at Buffalo, Buffalo, NY, USA.
authors.forename: G
authors.initials: G
authors.lastname: Kessler Evan
authors.affiliation: Division of Orthopedic Surgery. Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amar
authors.initials: A
authors.lastname: Eyal
authors.affiliation: Division of Orthopedic Surgery. Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Snir
authors.initials: S
authors.lastname: Nimrod
authors.affiliation: Division of Orthopedic Surgery. Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Rath
authors.initials: R
authors.lastname: Ehud
authors.affiliation: Division of Orthopedic Surgery. Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eizenberg
authors.initials: E
authors.lastname: Gilad
authors.affiliation: Division of Orthopedic Surgery. Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Steinberg L
authors.initials: SL
authors.lastname: Ely
mesh_terms: D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation; D017759:Fractures, Malunited / Q000517:prevention & control / Q000601:surgery*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012399:Rotation; D013530:Surgical Wound Infection / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Cutout; EPFN; GPFN; Intramedullary nail; Proximal femoral fracture