The Gliding Nail (GN). A Universal Implant for Immediate Weight Bearing Restauration in all Per- and Subtrochanteric Femur Fractures. Evaluation of 501 Patients

Summary form only given: Clinical problem: the cut out is one of the major and most severe complications in the management of trochanteric and subtrochanteric fractures in elderly patients due to osteoporosis. In experimental examinations we found a significant decrease of the cut through and out of the I beam profile femur neck component of the GN as compared to a single or double screw fixation. The main purpose of this study was therefore to analyse if it is possible to minimise the risk of implant related complications by using the GN osteosynthesis in all per- and subtrochanteric fractures. Material and methods: in a five year period 03.1996-03.2001 501 patients all patients with trochanteric and subtrochanteric fractures were evaluated. Reexamination was performed at least 6 months after therapy. All patients with no additional injury of the same leg were allowed full weight bearing immediately (98%). 70% were female, mean age 76.2 years, median 80 years. 82% had risk factors, 11.2% were in a nursing home. 95% were treated in the first 36 hours by 23 surgeons. Results: early local complications occurred in 2.5%. Only wound revisions for haematoma (11 cases with 5 times positive bacteriology) occurred but the general rate of complications was 28.5% especially urinary and pulmonary infections. Hospital mortality was 3.9%. Whereas the mortality in patients without risk factors the mortality was 2.4% when 4 risk factors were present mortality was 90%. Osteoporosis and diabetes had no influence as risk factor. Late local complications were 3.3%. In 1.9% blade dislocation but in no case cut out was observed. In all cases joint preserving reosteosynthesis was possible. Central impaction of the blade was minimal with 0.24 mm, varus displacement 0.7 degrees, the mean fracture impaction was only 2.2 mm due to the rotation stability of the blade so that the neck could not rotate to dorsal located bone defect. The 3 months mortality was 14.9% 15.3% were in a nursing home. Conclusion: the results show that the event of a trochanteric fracture is still a serious risk but local complications especially cut out of the implant and severe impaction of the fracture can be avoided by using the GN.