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Nailing intertrochanteric fractures in geriatric population: Do we know it all?
P Checa-Betegón1, Á Ramos-Fernández1, G Ciller-González1
1Hospital Universitario Clínico San Carlos, Profesor Martín Lagos sn, 28040 Madrid, Spain.
Summary
Short nails with dynamic distal locking provide effective treatment for pertrochanteric fractures in elderly patients. This method ensures good radiographic and functional outcomes with a low complication rate when proper surgical techniques are used.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Geriatric Medicine
Background:
- Pertrochanteric fractures are common in elderly individuals, posing significant challenges for orthopedic surgeons.
- Effective treatment is crucial for restoring function and improving quality of life in this demographic.
Purpose of the Study:
- To analyze radiographic parameters and clinical outcomes of stable and unstable intertrochanteric fractures.
- To evaluate the efficacy of short nails with dynamic distal locking in patients over 65.
Main Methods:
- Retrospective study of 272 patients (≥65 years) treated with Gamma3 Nail and dynamic distal locking (2017-2021).
- Analysis of pre-, intra-, and post-operative radiographic parameters, including AO/OTA classification, Singh's osteopenia grade, tip-to-apex distance, and medial cortical support.
- Assessment of functional outcomes (Barthel index), quality of life, and complications (non-union, cut-out).
Main Results:
- High rate of radiographic consolidation (97.4%) achieved.
- Optimal tip-to-apex distance (<25mm) and medial cortical support (88.6%) were associated with successful outcomes.
- Low reintervention rate (2.9%) including cut-outs (1.1%) and non-unions (1.1%).
Conclusions:
- Short nails with dynamic distal locking demonstrate good clinical, radiological, and functional results for all AO/OTA fracture patterns.
- Maintaining appropriate tip-to-apex distance and medial cortical support is key to minimizing complications.
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