Abstract
The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant.
Highlights
Trochanteric fractures of the femur are common in elderly individuals with osteoporosis and are usually treated surgically to facilitate early rehabilitation [1, 2]
The Gamma nail was introduced in the late 1980s and was the first widely available intramedullary device used for the fixation of trochanteric fractures, especially for unstable trochanteric and subtrochanteric fractures [7]
The implant consists of a sliding lag screw that passes through a short intramedullary nail and two distal locking screws that pass through the nail tip to secure it to the femoral shaft
Summary
Trochanteric fractures of the femur are common in elderly individuals with osteoporosis and are usually treated surgically to facilitate early rehabilitation [1, 2]. The use of intramedullary nails is increasing, and they are the most commonly used fixation devices, especially for the treatment of unstable trochanteric fractures [5, 6]. An increased incidence of secondary femoral shaft fractures was reported with use of the first generation Gamma nail compared with the SHS. These fractures were attributed largely to the first generation design features and led to modifications including downsizing of the nail [8, 14, 15]. The third generation Gamma nail was introduced in 2003 and features decreased proximal nail diameter, lag screw diameter with a new screw thread design, and distal locking screw diameter. We review the literature and discuss the incidence, the causes, and treatment of implant failure
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