{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T06:51:03Z","timestamp":1778914263707,"version":"3.51.4"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T00:00:00Z","timestamp":1576627200000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Introduction<\/jats:title>\n<jats:p>Pertrochanteric fractures (PFs) frequently affect the lower limb of osteoporotic patients and represent an important cause of morbidity and mortality in the elderly. In this prospective randomized controlled trial, we have compared functional and radiological results and complications of patients affected by PFs treated with two intramedullary proximal femoral nails.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Materials<\/jats:title>\n<jats:p>We enrolled 323 subjects with PFs, classified according to AO\/OTA system as 31.A1 (pertrochanteric simple) and 31.A2 (pertrochanteric multifragmentary). Patients were divided into two groups according to the osteosynthesis devices: group A, Elos-Intrauma\u00ae nail (155 cases) and group B, Gamma 3-Stryker\u00ae nail (168 cases). Pre-operatively, the baseline characteristics of each patient (gender, age, weight and BMI) were collected. Intraoperative blood loss, subjective pain by visual analogue scale (VAS), esthetic satisfaction, functional scores of the hip by Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were noted. The post-operative degree of fracture reduction was assessed. Each patient had a minimum follow-up of 12\u2009months.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The study group was composed of 106\u2009male and 217 female with an average age of 85.4 (range, 65\u201390, standard deviation (SD) 5.95) years. No statistical differences about sex and age distribution were noted between the two groups. Group A reported lower intraoperative blood loss, 45\u2009ml vs 51\u2009ml, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). There was not any statistical difference about operative time. Group A had a better reduction of fracture (<jats:italic>p<\/jats:italic>\u2009=\u20090.0347). The greatest difference was detectable comparing subgroups 31.A2 (<jats:italic>p<\/jats:italic>\u2009=\u20090.032). There were no statistical differences about complication frequency and the overall rate was 25% (80 cases). Finally, there was no difference in terms of VAS, HHS, and WOMAC score between the two groups on each follow-up. Patients of group A showed a higher subjective satisfaction index at 1 post-operative year, 7.42 (SD 1.19) vs 6.45 (SD 1.35) of group B (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Elos\u00ae nail is a reliable device on a short-term follow-up and represents an alternative choice to the Gamma 3\u00ae nail, a well-known and appreciated system for over 25\u2009years.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13018-019-1506-1","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T13:02:53Z","timestamp":1576674173000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices"],"prefix":"10.1186","volume":"14","author":[{"given":"Pompeo","family":"Catania","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6221-7027","authenticated-orcid":false,"given":"Daniele","family":"Passaretti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Montemurro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Ripanti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Carbone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittorio","family":"Candela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Carnovale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Gumina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francecsco","family":"Pallotta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,12,18]]},"reference":[{"key":"1506_CR1","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1007\/s00264-006-0251-3","volume":"31","author":"K Bjorgul","year":"2007","unstructured":"Bjorgul K, Reikeras O. Incidence of hip fracture in southeastern Norway: a study of 1,730 cervical and trochanteric fractures. Int Orthop. 2007;31:665\u20139.","journal-title":"Int Orthop"},{"key":"1506_CR2","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1097\/00003086-200402000-00028","volume":"419","author":"V Finsen","year":"2004","unstructured":"Finsen V, Johnsen LG, Trano G, Hansen B, Sneve KS. Hip fracture incidence in central Norway: a followup study. Clin Orthop Relat Res. 2004;419:173\u20138.","journal-title":"Clin Orthop Relat Res"},{"key":"1506_CR3","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1046\/j.1532-5415.2003.51110.x","volume":"51","author":"RS Braithwaite","year":"2003","unstructured":"Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatric Soc. 2003;51:364\u201370.","journal-title":"J Am Geriatric Soc"},{"key":"1506_CR4","doi-asserted-by":"publisher","first-page":"361","DOI":"10.2106\/00004623-200502000-00019","volume":"87","author":"I Weller","year":"2005","unstructured":"Weller I, Wai EK, Jaglal S. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. JBJS Br. 2005;87:361\u20136.","journal-title":"JBJS Br"},{"key":"1506_CR5","first-page":"CD000093","volume":"4","author":"MJ Parker","year":"2002","unstructured":"Parker MJ, Handoll HH. Gamma and other cephalo-condylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev. 2002;4:CD000093.","journal-title":"Cochrane Database Syst Rev"},{"key":"1506_CR6","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1016\/j.injury.2005.03.003","volume":"36","author":"K Sehat","year":"2005","unstructured":"Sehat K, Baker RP, Pattison G, Price R, Harries WJ, Chesser TJS. The use of the long gamma nail in proximal femoral fractures. Injury. 2005;36:1350\u20134.","journal-title":"Injury"},{"key":"1506_CR7","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/0020-1383(89)90120-4","volume":"20","author":"AHRW Simpson","year":"1989","unstructured":"Simpson AHRW, Varty K, Dodd CAF. Sliding hip screws: modes of failure. Injury. 1989;20:227\u201331.","journal-title":"Injury"},{"key":"1506_CR8","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1002\/jor.1100020312","volume":"2","author":"AF Tencer","year":"1984","unstructured":"Tencer AF, Johnson KD, Johnston DWC, Gill K. A biomechanical comparison of various methods of stabilization of subtrochanteric fracture of the femur. J Orthop Res. 1984;2:297\u2013305.","journal-title":"J Orthop Res"},{"key":"1506_CR9","doi-asserted-by":"publisher","first-page":"700","DOI":"10.2106\/JBJS.G.00517","volume":"90","author":"JO Anglen","year":"2008","unstructured":"Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice\u2014a review of the American Board of Orthopedic Surgery Database. JBJS Am. 2008;90:700\u20137. https:\/\/doi.org\/10.2106\/JBJS.G.00517.","journal-title":"JBJS Am"},{"key":"1506_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/143598","volume":"2014","author":"Dimitrios Georgiannos","year":"2014","unstructured":"Georgiannos D, Lampridis V, Bisbinas I. Complications following treatment of trochanteric fractures with the Gamma 3 nail: is the latest version of gamma nail superior to its predecessor? Hindawi Publishing Corporation Surgery Research and Practice 2014: Article ID 143598. doi:https:\/\/doi.org\/10.1155\/2014\/143598.","journal-title":"Surgery Research and Practice"},{"key":"1506_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12306-015-0391-y","volume":"100","author":"R Pascarella","year":"2016","unstructured":"Pascarella R, Fantasia R, Maresca A, Bettuzzi C, Amendola L, Violini S, et al. How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System. Musculoskelet Surg. 2016;100:1\u20138. https:\/\/doi.org\/10.1007\/s12306-015-0391-y.","journal-title":"Musculoskelet Surg."},{"key":"1506_CR12","first-page":"175","volume":"33","author":"L Cipollaro","year":"2019","unstructured":"Cipollaro L, Aicale R, Maccauro G, Maffulli N. Single-versus double-integrated screws in intramedullary nailing systems for surgical management of extracapsular hip fractures in the elderly: a systematic review. J Biol Regul Homeost Agents. 2019;33:175\u201382.","journal-title":"J Biol Regul Homeost Agents"},{"key":"1506_CR13","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s13018-018-0814-1","volume":"13","author":"R Aicale","year":"2018","unstructured":"Aicale R, Maffulli N. Greater rate of cephalic screw mobilization following proximal femoral nailing in hip fractures with a tip-apex distance (TAD) and a calcar referenced TAD greater than 25\u2009mm. J Orthop Surg Res. 2018;13:106. https:\/\/doi.org\/10.1186\/s13018-018-0814-1.","journal-title":"J Orthop Surg Res"},{"key":"1506_CR14","doi-asserted-by":"publisher","first-page":"385","DOI":"10.5505\/tjtes.2015.72173","volume":"21","author":"G Uzer","year":"2015","unstructured":"Uzer G, Elmadag NM, Y\u0131ld\u0131z F, Bilsel K, Erden T, Toprak H. Comparison of two types of proximal femoral hails in the treatment of intertrochanteric femur fractures. Ulus Travma Acil Cerrahi Derg. 2015;21:385\u201391. https:\/\/doi.org\/10.5505\/tjtes.2015.72173.","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"1506_CR15","doi-asserted-by":"crossref","unstructured":"Buckley RE; Moran CG; Apivatthakakul T. AO Principles of fracture management. 3rd edition. Ed Thieme 2017. ISBN 3132423106, 9783132423107.","DOI":"10.1055\/b-0038-160811"},{"key":"1506_CR16","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1016\/j.injury.2008.10.014","volume":"40","author":"P Mereddy","year":"2009","unstructured":"Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO\/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury. 2009;40:428\u201332. https:\/\/doi.org\/10.1016\/j.injury.2008.10.014.","journal-title":"Injury"},{"key":"1506_CR17","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1016\/j.otsr.2014.06.012","volume":"100","author":"B Zhong","year":"2014","unstructured":"Zhong B, Zhang Y, Zhang C, Luo CF. A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures. Orthop Traumatol Surg Res. 2014;100:663\u20138. https:\/\/doi.org\/10.1016\/j.otsr.2014.06.012.","journal-title":"Orthop Traumatol Surg Res"},{"key":"1506_CR18","doi-asserted-by":"publisher","first-page":"737","DOI":"10.2106\/00004623-196951040-00012","volume":"51","author":"WH Harris","year":"1969","unstructured":"Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end\u00adresult study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737\u201355.","journal-title":"J Bone Joint Surg Am"},{"key":"1506_CR19","unstructured":"Bellamy N. WOMAC Osteoarthritis index user guide. Version V. Brisbane, Australia 2002."},{"key":"1506_CR20","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s00402-003-0586-9","volume":"124","author":"F Fogagnolo","year":"2004","unstructured":"Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124:31\u20137. https:\/\/doi.org\/10.1007\/s00402-003-0586-9.","journal-title":"Arch Orthop Trauma Surg"},{"key":"1506_CR21","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1186\/1471-2474-13-214","volume":"13","author":"C Giessauf","year":"2012","unstructured":"Giessauf C, Glehr M, Bernhardt GA, Seibert FJ, Gruber K, Sadoghi P, et al. Quality of life after perthrocanteric femoral fractures treated with a gamma nail: a single center study of 62 patients. Muscol Disord. 2012;13:214. https:\/\/doi.org\/10.1186\/1471-2474-13-214.","journal-title":"Muscol Disord"},{"key":"1506_CR22","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1186\/1756-0500-5-651","volume":"5","author":"B Buecking","year":"2012","unstructured":"Buecking B, Bliemel C, Struwer J, Eschbach D, Ruchholtz S, M\u00fcller T. Use of the Gamma3\u2122 nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life. BMC Res Notes. 2012;5:651. https:\/\/doi.org\/10.1186\/1756-0500-5-651.","journal-title":"BMC Res Notes"},{"key":"1506_CR23","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1007\/s00402-016-2410-3","volume":"136","author":"A Turgut","year":"2016","unstructured":"Turgut A, Kalenderer O, Karap\u0131nar L, Kumbarac\u0131 M, Akkan HA, Agu\u015f H. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients. Arch Orthop Trauma Surg. 2016;136:623\u201330. https:\/\/doi.org\/10.1007\/s00402-016-2410-3.","journal-title":"Arch Orthop Trauma Surg"},{"key":"1506_CR24","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1097\/BOT.0b013e31819211b2","volume":"23","author":"AH Ruecker","year":"2009","unstructured":"Ruecker AH, Rupprecht M, Gruber M, Gebauer M, Barvencik F, Briem D, et al. e treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma. 2009;23:22\u201330.","journal-title":"J Orthop Trauma"},{"key":"1506_CR25","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1055\/s-2005-836453","volume":"143","author":"P Megas","year":"2005","unstructured":"Megas P, Kaisidis A, Zouboulis P, Papas M, Panagopoulos A, Lambiris E. Comparative study of the treatment of pertrochanteric fractures--trochanteric gamma nail vs. proximal femoral nail. Z Orthop Ihre Grenzgeb. 2005;143:252\u20137.","journal-title":"Z Orthop Ihre Grenzgeb"},{"key":"1506_CR26","doi-asserted-by":"publisher","first-page":"288","DOI":"10.3928\/01477447-20130222-16","volume":"36","author":"S Zhang","year":"2013","unstructured":"Zhang S, Zhang K, Jia Y, Yu B, Feng W. InterTan nail versus proximal femoral nail antirotation-Asia in the treatment of unstable trochanteric fractures. Orthopedics. 2013;36:288\u201394. https:\/\/doi.org\/10.3928\/01477447-20130222-16.","journal-title":"Orthopedics"},{"key":"1506_CR27","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","volume":"21","author":"JL Marsh","year":"2007","unstructured":"Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium 2007: orthopedic trauma association classification, database and outcomes committee. J Orthop Trauma. 2007;21:S1\u201333.","journal-title":"J Orthop Trauma"},{"key":"1506_CR28","doi-asserted-by":"publisher","first-page":"179","DOI":"10.5435\/00124635-200405000-00006","volume":"12","author":"DM Lindskog","year":"2004","unstructured":"Lindskog DM, Baumgaertner MR. Unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg. 2004;12:179\u201390.","journal-title":"J Am Acad Orthop Surg"},{"key":"1506_CR29","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.2106\/00004623-199912000-00002","volume":"81","author":"MS Kocher","year":"1999","unstructured":"Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg. 1999;81:1662\u201370.","journal-title":"J Bone Joint Surg"},{"key":"1506_CR30","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1177\/230949901001800206","volume":"18","author":"CC Wu","year":"2010","unstructured":"Wu CC, Tai CL. Effect of lag-screw positions on modes of fixation failure in elderly patients with unstable intertrochanteric fractures of the femur. J Orthop Surg. 2010;18:158\u201365. https:\/\/doi.org\/10.1177\/230949901001800206.","journal-title":"J Orthop Surg"},{"key":"1506_CR31","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/1749-799X-8-35","volume":"8","author":"AN Nikoloski","year":"2013","unstructured":"Nikoloski AN, Osbrough AL, Yates PJ. Should the tip- apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;8:35. https:\/\/doi.org\/10.1186\/1749-799X-8-35.","journal-title":"A retrospective study. J Orthop Surg Res"},{"key":"1506_CR32","first-page":"441","volume":"53","author":"DG Lorich","year":"2004","unstructured":"Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect. 2004;53:441\u201354.","journal-title":"Instr Course Lect"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-019-1506-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13018-019-1506-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-019-1506-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T00:50:58Z","timestamp":1608166258000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-019-1506-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["1506"],"URL":"https:\/\/doi.org\/10.1186\/s13018-019-1506-1","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"14 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 December 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"According to Italian law, this study did not require any ethics committee approval.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors provide their consent to the subscription and publication of this manuscript and all related files.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"449"}}