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題名 | Risk Factors for Cut-out Failure of Gamma3 Nails in Treating Unstable Intertrochanteric Fractures: An Analysis of 176 Patients |
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作者姓名(外文) | Tsai, Shang-wen; Lin, Jeff Chien-fu; Tzeng, Yun-hsuan; Lin, Chun-cheng; Huang, Ching-kuei; Chang, Ming-chau; Chiang, Chao-ching; | 書刊名 | Journal of the Chinese Medical Association |
卷期 | 80:9 2017.09[民106.09] |
頁次 | 頁587-594 |
分類號 | 416.26 |
關鍵詞 | Cut-out; Failure; Gamma nail; Intertrochanteric fracture; Risk factor; |
語文 | 英文(English) |
英文摘要 | Background: Cut-out failure is one of the most common complications in the Gamma3 nail fixation system. The purpose of this retrospective study was to determine pre-operative or intra-operative risk factors for cut-out failure of lag screws in unstable, intertrochanteric fractures fixed with short Gamma3 nails. Methods: One hundred and seventy-six patients over 60 years of age, with unstable intertrochanteric fractures (AO/OTA 31-A2, 31-A3) treated with short Gamma3 nails were included in this study. All patients completed a minimum of 1-year follow-up. Analysis of post-operative radiographs included assessment for cut-out failure of lag screw, appropriateness of the entry point, posterior lag screw axis, fracture gaps, posterior displacement of the proximal fragment, and tip-apex distance. Results: Of the 176 patients in this study, 22 patients were identified with cut-out failure. Multivariate logistic regression analysis revealed that improper entry point in an antero-posterior projection (odds ratio 10.39, 95% confidence interval 1.74e78.4), posterior displacement distance of the proximal fragment in a lateral projection (odds ratio 1.35, 95% confidence interval 1.17e1.59), and female sex (odds ratio 17.14, 95% confidence interval 1.88e876.11) were correlated with cut-out failure. Conclusion: This study emphasizes the importance of an optimal position of reduction in the lateral projection in reducing the risk of cut-out failure. In addition, sex difference in bone mineral density, proximal femur geometry, and the bone strength in elderly females may explain why female sex is a risk factor. |
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