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Revue de Chirurgie Orthopédique et Traumatologique
Vol 88, N° 3  - mai 2002
pp. 264-270
Doi : RCO-05-2002-88-3-0035-1040-101019-ART6
Enclouage par clou gamma long dans les fractures sous-trochantériennes et trochantéro-diaphysaires du fémur de l'adulte
 

F. Dubrana [1], Y. Poureyron [1], J. Tram [1], M. Genestet [1], C. Rizzo [1], D. Le Nen [1], C. Lefevre [1]
[1]  Service d'Orthopédie et de Traumatologie, CHU Cavale-Blanche, 29609 Brest Cedex.

Tirés à part : F. Dubrana [1]

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Vingt-deux patients ont été traités par un clou gamma long pour fracture sous-trochantérienne ou trochantéro-diaphysaire et suivis plus de 6 mois. L'âge moyen était de 68 ans (42 à 96 ans). La durée de l'intervention était de 70 minutes. Un appui protégé immédiat a été possible 16 fois. La consolidation a été considérée acquise à la douzième semaine. A trois mois, tous les patients utilisaient une aide pour marcher ; à six mois, quatre patients utilisaient un déambulateur. Nous avons comparé nos résultats à neuf séries de la littérature utilisant d'autres méthodes thérapeutiques (vis-plaque, clous-plaques et clous de Ender). Le traitement par clou gamma long ne permet pas une réduction anatomique du foyer fracturaire, cependant il favorise la consolidation et il réduit le risque infectieux.

Abstract
Long gamma nail for the treatment of subtrochanteric fracture of the femur
Purpose of the study

The standard gamma nail is commonly used for the treatment of trochanteric fractures but cannot be used if the fracture lies at the level of the distal locking. Theoretically, the long gamma nail would overcome this inconvenience and could be used for all cases of subtrochanteric and trochanteric-shaft fractures.

Material and methods

Clinical and radiological charts were established in 1990 for a multicentric study. The radiology work-up included an AP view of the pelvis and an oblique lateral view of the hip. Two classifications were used: Seinsheimer and Muller as modified by Nazarian. Three stages of fracture reduction were recorded: 1 = anatomic reduction, 2 = acceptable reduction, 3 = poor reduction. From January 1995 to December 1999, 46 patients were treated with the long gamma nail. Twenty-four cases were excluded for various reasons (from wich 3 early death). 22 remaining patients were followed for more than six months. Mean age was 68 years (range 42-96); there were six women and 16 men. Ten patients were traffic or work accident victims and 12 had had a home accident.

Results

Mean duration of surgery was 70 minutes. Three patients required revision surgery within a week of the initial osteosynthesis. Mean hemoglobin level before surgery was 12.9 g/dl; 8.9 g/dl during the first postoperative week. Mean hospital stay was 14 days. Weight-bearing with support was possible early after surgery in 16 patients who walked with crutches or a walker. Mean delay to weight-bearing was 11 days. At three months, all patients were using an aid for walking; at six months, four patients used a walker. Bone healing was achieved on the average at the twelfth week. Radiological reduction was anatomic in four, acceptable in three and poor in 15.

Discussion

We advocate the AO classification as it allows a structured analysis of all fractures within a unique system. We compared our results with nine series reported in the literature using other therapeutic methods (screw-plate, nail-plate, Ender nail). The operative time for the long gamma nail (70 min) was comparable with that for other surgical techniques. Treatment with the long gamma nail favors bone healing and limits the risk of infection. Radiological results in our series were poor, but there were no cases with nonunion and the morbidity was low.


Mots clés : Fémur , fracture trochantérienne , fracture trochantéro-diaphysaire , enclouage trochantérien

Keywords: Femur , subtrochanteric fracture , trochanteric nail






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