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A comparative prospective study of dynamic variable angle hip screw and Gamma nail in intertrochanteric hip fractures
Umberto Tarantino1, Francesco Oliva, Angelo Impagliazzo
1University of Rome Tor Vergata, Faculty of Medicine and Surgery, Department of Orthopaedics and Traumatology, Rome, Italy.
Purpose:
To compare the results between a variable angle dynamic screw-plate(DMS) and the Gamma nail in the treatment of intertrochanteric hip fractures.
Methods:
A comparative prospective study of 142 patients (AO/OTA Type 31-A1; A2; A3 and B2) treated by variable angle dynamic screw-plate (DMS Group = 71) or by intramedullary nailing (Gamma Nail Group = 71).
Results:
At the 12-month follow-up, we did not find any statistically significant difference, intraoperatively, radiographically, or clinically, between the two groups of patients, except for shortening. In 12 patients in the DMS group (17%) and in one patient in the Gamma nail group, there was shortening of the operated leg between 1 cm and 3 cm (p = 0.02). In all instances, shortening occurred in patients who sustained A.O. type fractures 31A2. 2 and 3 (19 patients), which are unstable and comminuted.
Conclusions:
The DMS allows effective management of intertrochanteric fractures of the femur. Surgeons should consider choosing surgical treatment according to the type of intertrochanteric fracture. In less comminuted fractures, a compression hip screw may be a faster and safer surgical solution. In comminuted fractures, surgical difficulties may increase in parallel to fracture complexity.