Abstract

BackgroundFixation of trochanteric hip fractures using the Gamma Nail has been performed since 1988 and is today well established and wide-spread. However, a number of reports have raised serious concerns about the implant's complication rate. The main focus has been the increased risk of a subsequent femoral shaft fracture and some authors have argued against its use despite other obvious advantages, when this implant is employed.Through access to a uniquely large patient data base available, which is available for analysis of trochanteric fractures; we have been able to evaluate the performance of the Gamma Nail over a twelve year period.Methods3066 consecutive patients were treated for trochanteric fractures using Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l'Orthopedie (CTO), Strasbourg, France. These patients were retrospectively analysed. Information on epidemiological data, intra- and postoperative complications and patients' outcome was retrieved from patient notes. All available radiographs were assessed by a single reviewer (AJB).ResultsThe results showed a low complication rate with the use of the Gamma Nail. There were 137 (4.5%) intraoperative fracture-related complications. Moreover 189 (6.2%) complications were detected postoperatively and during follow-up. Cut-out of the lag screw from the femoral head was the most frequent mechanical complication (57 patients, 1.85%), whereas a postoperative femoral shaft fracture occurred in 19 patients (0.6%). Other complications, such as infection, delayed healing/non-union, avascular femoral head necrosis and distal locking problems occurred in 113 patients (3.7%).ConclusionsThe use of the Gamma Nail in trochanteric hip fractures is a safe method with a low complication rate. In particular, a low rate of femoral shaft fractures was reported. The low complication rate reported in this series can probably be explained by strict adherence to a proper surgical technique.

Highlights

  • Fixation of trochanteric hip fractures using the Gamma Nail has been performed since 1988 and is today well established and wide-spread

  • The results showed a low complication rate with the use of the Gamma Nail

  • The use of the Gamma Nail in trochanteric hip fractures is a safe method with a low complication rate

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Summary

Introduction

Fixation of trochanteric hip fractures using the Gamma Nail has been performed since 1988 and is today well established and wide-spread. Gamma Nail development started coincidentally in two places in independent and in parallel processes It was developed in Halifax, UK, in an attempt to overcome some of the clinical problems with the Zickel nail [2,3] an intramedullary implant used for the treatment of pathologic subtrochanteric fractures. Full list of author information is available at the end of the article similar implant for same indications was developed at the CTO, Strasbourg, France. These two projects were merged and after a number of clinical evaluations and modifications to both implants and instruments, by 1988 one design emerged designated hereafter as "The Standard Gamma Nail" (SGN)

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