الفهرس 
Historical Review
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Intertrochanteric fractures are a common problem with an increasing incidence especially among old age groups. Unstable types are more challenging in their management. Accurate realignment and rigid fixation, allowing early mobilization after surgical intervention is the main goal during treatment of these fractures. Proper implant choice is crucial in intertrochanteric fracture management.
The proper implant must be chosen based on fracture stability. Although the extra medullary devices such as DHS remain the standard choice for the treatment of stable intertrochanteric fractures, they are accompanied by high failure rates in unstable fractures and they require increased surgical dissection and operative time. The intramedullary implants as the Gamma III nail could be used providing a stable construct with fewer failure rates, less surgical dissection, less blood loss and less operative time.
The aim of this study was to compare the clinical and radiological outcome between Dynamic hip screw and the third generation of Gamma nail in management of intertrochanteric fractures AO Classification Subgroup 31-A1 3.
For this purpose, this study was conducted on 37 patients with intertrochanteric fractures AO classification Subgroup 31-A1.3, which included in this study consecutively admitted to department of orthopedic surgery and traumatology in Hosh Eissa Hospital at El Beheira Governorate and orthopedic department at Menofia university Hospital. Probability, systematic random sampling technique of patients was included in this study which case treated by GAMMA Nail then DHS and
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the same sequence, all patients were operated within the first 2 weeks of injury.
They were operated on using GAMMA Nail and DHS which 18 cases was managed by DHS (group І) and also, 19 cases was managed by GAMMA Nail (group ІІ ) and missed 3 cases one of them treated by DHs and two by GAMMA Nail, therefore, total number of cases 34 patients , 17 for each group. Data collection period from November 2019 to January 2021 and follow up period for each patient 6 months.
The results clarified that was difference in gender distribution; in both groups with 10 females and 7 males in-group I while in group II 9 females and 8 males. The most common occupational category in group I was house wives (47%) followed by retired (35%) then still working (11.8%) and no work (5.9 %) while in group II the most common category was retired with incidence of 41% followed by house wives (35.3%). The majority of patients had right sided lesion (52.94 % for group I and 70.62 % for group II) however the differences in lesion side were not statistically significant.
As regards to mode of trauma, group one 13 patients suffered from falling down (F.D) and only 4 patient had Road Traffic Accidents (RTA) while in group II 5 patients had Road Traffic Accidents and 12 patients suffered from falling down (F.D) Nine patients in group I had DM & HTN while 10 patients in-group II had DM & HTN and patients with no significant medical history were 8 in group I and 7 in group II and showed that there were no significant statistical differences between the two groups according to medical history.
According to the functional grading, the results were 14 satisfactory results and only 3 unsatisfactory results for group I, while group II were 15 satisfactory results and only 2 unsatisfactory results; however there
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were differences found in anatomical grading but again the differences were not statistically significant. It worth mention that satisfactory results defined as good or excellent union and unsatisfactory results defined as poor or fair union.
The differences in union time illustrated that the percentage of patients needed less than 12 weeks for union was 76.5 % and 82.3 % for group I and II respectively and the differences in the union time were not statistically significant. The differences in all operational parameters were not significant. Regarding to Smoking the results were statistically significant in-group I between smoking and time of union but insignificant in-group II.
The results of the two techniques were compared by means of functional and anatomical outcome. Functional, as well as anatomical outcome, was graded wither satisfactory or unsatisfactory. The results showed that there were no significant statistical differences between the outcome of the two techniques as regards to both functional and anatomical outcome. The results showed also no significant differences between outcome and both age and gender, although there were border line significant relation between the functional results and gender in group one but this was not a clinically important issue.