Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail?

Injury. 2016 Dec;47(12):2733-2738. doi: 10.1016/j.injury.2016.10.032. Epub 2016 Oct 29.

Abstract

Introduction: Poor bone quality and unstable fractures increase the cut-out rate in implants with gliding lag screws. The U-Blade (RC) lag screw for the Gamma3® nail was introduced to provide monoaxial rotational stability of the femoral head and neck fragment. The purpose of this study was to evaluate whether the use of the U-Blade (RC) lag screw is associated with reduced cut-out in patients with OTA/AO 31A1-3 fractures.

Material & methods: Between 2009 and 2014, 751 patients with OTA/AO 31A1-3 fractures were treated with a Gamma3® nail at our institution. Out of this sample 199 patients were treated with U-blade (RC) lag screws. A total of 135 patients (117 female, 18 male) with standard lag screw (treatment group A) were matched equally regarding age (±4 years) sex, fracture type and location to 135 patients with U-blade (RC) lag screw (treatment group B). Within a mean follow up of 9.2 months (range 6-18 months) we assessed the cut-out rate, the calTAD, lag screw migration, the Parker's mobility score and the Parker's ratio at postoperatively, six and 12 months following surgery. Furthermore we recorded all complications, ASA-Score, hospital stay and duration of surgery retrospectively.

Results: The most common fracture among group B with a cut-out of the lag screw were AO/OTA 2.3 and 3.2 fractures whereas in group A cut-out was most commonly seen in AO/OTA 2.1, 2.2 and 2.3 fractures, there was no significant reduction of the cut-out rate in group B 2.2% (n=3) compared to group A 3.7% (n=5). The duration of surgery was significantly shorter in group A (p<0.05). There was no significant difference in lag screw placement, the Parker's ratio and mobilization.

Conclusion: In our study the U-Blade (RC) lag screw did not reduce the cut-out in treatment of OTA/AO 31A1-3 fractures at all. Considering the longer duration of surgery and the higher costs of the U-Blade (RC) lag screw, our results do not justify its use. However, further prospective randomized studies will be necessary.

Keywords: AO/OTA 31.A1-3 femur fractures; Cut-out; Gamma3 nail; U-Blade (RC) lag screw.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Nails
  • Bone Screws
  • Female
  • Femoral Fractures / diagnostic imaging
  • Femoral Fractures / physiopathology
  • Femoral Fractures / surgery*
  • Femur Neck / diagnostic imaging
  • Femur Neck / pathology*
  • Fracture Fixation, Intramedullary*
  • Hip Fractures / diagnostic imaging
  • Hip Fractures / physiopathology
  • Hip Fractures / surgery*
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Failure
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome