Nailing intertrochanteric fractures in geriatric population: Do we know it all?

Area of Science:

• Orthopedic Surgery
• Traumatology
• Geriatric Medicine

Background:

• Pertrochanteric fractures are common in elderly patients, posing significant challenges for orthopedic surgeons.
• Effective treatment is crucial for restoring function and quality of life in this demographic.

Purpose of the Study:

• To analyze radiographic parameters and outcomes of stable and unstable intertrochanteric fractures.
• To evaluate the efficacy of short nails with dynamic distal locking in patients over 65 years old.

Main Methods:

• Retrospective study of 272 patients (age >65) treated with Gamma3 Nail (Stryker®) between 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.
• Evaluation of functional outcomes (Barthel index), complications (non-union, cut-out), and reinterventions.

Main Results:

• Radiographic consolidation achieved in 97.4% of cases with a mean follow-up of 18.2 months.
• Successful tip-to-apex distance (<25mm) in 95.6% and positive/neutral medial cortical support in 88.6% of cases.
• 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 essential for successful treatment and low complication rates.