Short-term effectiveness of Gamma 3 U-Blade system for osteoporotic intertrochanteric fractures in the elderly_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FAN Wenbin ^1,2,3 , SHI Liu ^1,2,3 , XIE Tian ^1,2,3 , ZHANG Cheng ^1,2,3 , CHEN Xiangxu ^1,2,3 , CHEN Hui ^1,2,3 ,  RUI Yunfeng ^1,2,3

1. Department of Orthopaedics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China;
2. Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China;
3. Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P. R. China;

Corresponding?author：

RUI Yunfeng, Email: ruiyunfeng@126.com

Keywords：

Intertrochanteric fracture; Gamma 3 U-Blade system; intramedullary nail; internal fixation; osteoporosis; the elderly

DOI：

10.7507/1002-1892.202407041

Video：

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Objective To compare the short-term effectiveness between Gamma 3 intramedullary nails and Gamma 3 U-Blade system in the treatment of osteoporotic intertrochanteric fractures in the elderly. Methods A retrospective analysis was conducted on the clinical data of 124 elderly patients with osteoporotic intertrochanteric fractures, who were admitted between February 2020 and February 2023 and met the selection criteria. The fractures were fixed with Gamma 3 intramedullary nails in 65 patients (control group) and Gamma 3 U-Blade systems in 59 patients (UB group). The differences between the two groups were not significant in age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, bone mineral density, time from injury to operation, fracture classification, and affected side (P>0.05). The operation time, intraoperative blood loss, hospital stay, and fracture healing time were recorded; the tip-apex distance, fracture reduction quality, and lag screw position were evaluated on X-ray films at immediate after operation; the lag screw sliding distance and change value of neck-shaft angle were measured on X-ray films at last follow-up. Harris hip score at 1 year after operation and the occurrence of internal fixation-related complications were compared between the two groups. Results The operation time, intraoperative blood loss, and hospital stay in the UB group increased compared to the control group, but the differences were not significant (P>0.05). All patients in both groups were followed up 12-24 months (mean, 17.1 months). At 12 months after operation, there was no significant difference in the Harris hip score between the two groups (P<0.05). Radiological examination showed that there was no significant difference between the two groups (P>0.05) in terms of tip-apex distance, fracture reduction quality, and lag screw position. Fractures healed in both groups, and there was no significant difference in healing time (P>0.05). At last follow-up, the change value of neck-shaft angle and lag screw sliding distance in the UB group were significantly lower than those in the control group (P<0.05). During follow-up, no related complications occurred in the UB group, while 6 cases (9.2%) in the control group experienced complications, and the difference in the incidence was significant (P<0.05). Conclusion For the osteoporotic intertrochanteric fractures in the elderly, the Gamma 3 U-Blade system fixation can achieve good short-term effectiveness, with better imaging results compared to Gamma 3 intramedullary nails fixation.

Citation： FAN Wenbin, SHI Liu, XIE Tian, ZHANG Cheng, CHEN Xiangxu, CHEN Hui, RUI Yunfeng. Short-term effectiveness of Gamma 3 U-Blade system for osteoporotic intertrochanteric fractures in the elderly. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(1): 47-52. doi: 10.7507/1002-1892.202407041 Copy

1.	Adeyemi A, Delhougne G. Incidence and economic burden of intertrochanteric fracture: a medicare claims database analysis. JB JS Open Access, 2019, 4(1): e0045. doi: 10.2106/JBJS.OA.18.00045.
2.	Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
3.	Zhang YW, Lu PP, Li YJ, et al. Prevalence, characteristics, and associated risk factors of the elderly with hip fractures: A cross-sectional analysis of NHANES 2005-2010. Clin Interv Aging, 2021, 16: 177-185.
4.	Sun D, Wang C, Chen Y, et al. A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures. Medicine (Baltimore), 2019, 98(37): e17010. doi: 10.1097/MD.0000000000017010.
5.	Socci AR, Casemyr NE, Leslie MP, et al. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J, 2017, 99-B(1): 128-133.
6.	Lang NW, Arthold C, Joestl J, et al. Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail? Injury, 2016, 47(12): 2733-2738.
7.	Yoo J, Kim S, Choi J, et al. Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others? J Orthop Surg Res, 2019, 14(1): 440. doi: 10.1186/s13018-019-1427-z.
8.	Ryu HG, Choi YT, Kim SM, et al. A comparison of U-blade Gamma3 and Gamma3 Nails used for the treatment of intertrochanteric fractures. Hip Pelvis, 2020, 32(1): 50-57.
9.	Oh S, Kim YS, Kwon SY, et al. Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures. Sci Rep, 2021, 11(1): 17417. doi: 10.1038/s41598-021-96988-z.
10.	吳石磊, 焦競, 黃玉成, 等. Gamma3U-Blade系統與Gamma3釘固定治療老年不穩定型股骨轉子間骨折的近期療效比較. 中華創傷骨科雜志, 2022, 24(3): 258-261.
11.	陳時益, 張世民, 熊文峰, 等. 股骨轉子間骨折前方骨折線對髓內釘術后前側皮質復位丟失的影響. 中國修復重建外科雜志, 2024, 38(4): 391-397.
12.	張世民, 胡孫君, 杜守超, 等. 股骨轉子間骨折的穩定性重建概念演化與研究進展. 中國修復重建外科雜志, 2019, 33(10): 1203-1209.
13.	茆瑋, 何益群, 董有海. 股骨轉子間骨折手術中螺釘位置的研究進展. 中國矯形外科雜志, 2019, 27(6): 530-535.
14.	Serrano R, Blair JA, Watson DT, et al. Cephalomedullary nail fixation of intertrochanteric femur fractures: are two proximal screws better than one? J Orthop Trauma, 2017, 31(11): 577-582.
15.	Lenich A, Vester H, Nerlich M, et al. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip—Blade vs screw. Injury, 2010, 41(12): 1292-1296.
16.	Chinzei N, Hiranaka T, Niikura T, et al. Comparison of the sliding and femoral head rotation among three different femoral head fixation devices for trochanteric fractures. Clin Orthop Surg, 2015, 7(3): 291-297.
17.	Michael D, Yaniv W, Tal FR, et al. Expandable proximal femoral nail versus gamma proximal femoral nail for the treatment of AO/OTA 31A1-3 fractures. Injury, 2016, 47(2): 419-423.
18.	Yang YH, Wang YR, Jiang SD, et al. Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures? Singapore Med J, 2013, 54(8): 446-450.
19.	Kwak DK, Kim WH, Lee SJ, et al. Biomechanical comparison of three different intramedullary nails for fixation of unstable basicervical intertrochanteric fractures of the proximal femur: experimental studies. Biomed Res Int, 2018, 2018: 7618079. doi: 10.1155/2018/7618079.
20.	費林聰, 鄭徐洲, 徐學鵬, 等. 股骨轉子間骨折頭頸釘位置評估方式研究進展. 中國修復重建外科雜志, 2023, 37(9): 1149-1155.

1. Adeyemi A, Delhougne G. Incidence and economic burden of intertrochanteric fracture: a medicare claims database analysis. JB JS Open Access, 2019, 4(1): e0045. doi: 10.2106/JBJS.OA.18.00045.
2. Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric femur fracture treatment in Asia: What we know and what the world can learn. Orthop Clin North Am, 2020, 51(2): 189-205.
3. Zhang YW, Lu PP, Li YJ, et al. Prevalence, characteristics, and associated risk factors of the elderly with hip fractures: A cross-sectional analysis of NHANES 2005-2010. Clin Interv Aging, 2021, 16: 177-185.
4. Sun D, Wang C, Chen Y, et al. A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures. Medicine (Baltimore), 2019, 98(37): e17010. doi: 10.1097/MD.0000000000017010.
5. Socci AR, Casemyr NE, Leslie MP, et al. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J, 2017, 99-B(1): 128-133.
6. Lang NW, Arthold C, Joestl J, et al. Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail? Injury, 2016, 47(12): 2733-2738.
7. Yoo J, Kim S, Choi J, et al. Gamma 3 U-Blade lag screws in patients with trochanteric femur fractures: are rotation control lag screws better than others? J Orthop Surg Res, 2019, 14(1): 440. doi: 10.1186/s13018-019-1427-z.
8. Ryu HG, Choi YT, Kim SM, et al. A comparison of U-blade Gamma3 and Gamma3 Nails used for the treatment of intertrochanteric fractures. Hip Pelvis, 2020, 32(1): 50-57.
9. Oh S, Kim YS, Kwon SY, et al. Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures. Sci Rep, 2021, 11(1): 17417. doi: 10.1038/s41598-021-96988-z.
10. 吳石磊, 焦競, 黃玉成, 等. Gamma3U-Blade系統與Gamma3釘固定治療老年不穩定型股骨轉子間骨折的近期療效比較. 中華創傷骨科雜志, 2022, 24(3): 258-261.
11. 陳時益, 張世民, 熊文峰, 等. 股骨轉子間骨折前方骨折線對髓內釘術后前側皮質復位丟失的影響. 中國修復重建外科雜志, 2024, 38(4): 391-397.
12. 張世民, 胡孫君, 杜守超, 等. 股骨轉子間骨折的穩定性重建概念演化與研究進展. 中國修復重建外科雜志, 2019, 33(10): 1203-1209.
13. 茆瑋, 何益群, 董有海. 股骨轉子間骨折手術中螺釘位置的研究進展. 中國矯形外科雜志, 2019, 27(6): 530-535.
14. Serrano R, Blair JA, Watson DT, et al. Cephalomedullary nail fixation of intertrochanteric femur fractures: are two proximal screws better than one? J Orthop Trauma, 2017, 31(11): 577-582.
15. Lenich A, Vester H, Nerlich M, et al. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip—Blade vs screw. Injury, 2010, 41(12): 1292-1296.
16. Chinzei N, Hiranaka T, Niikura T, et al. Comparison of the sliding and femoral head rotation among three different femoral head fixation devices for trochanteric fractures. Clin Orthop Surg, 2015, 7(3): 291-297.
17. Michael D, Yaniv W, Tal FR, et al. Expandable proximal femoral nail versus gamma proximal femoral nail for the treatment of AO/OTA 31A1-3 fractures. Injury, 2016, 47(2): 419-423.
18. Yang YH, Wang YR, Jiang SD, et al. Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures? Singapore Med J, 2013, 54(8): 446-450.
19. Kwak DK, Kim WH, Lee SJ, et al. Biomechanical comparison of three different intramedullary nails for fixation of unstable basicervical intertrochanteric fractures of the proximal femur: experimental studies. Biomed Res Int, 2018, 2018: 7618079. doi: 10.1155/2018/7618079.
20. 費林聰, 鄭徐洲, 徐學鵬, 等. 股骨轉子間骨折頭頸釘位置評估方式研究進展. 中國修復重建外科雜志, 2023, 37(9): 1149-1155.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of Gamma 3 U-Blade system for osteoporotic intertrochanteric fractures in the elderly

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