The Treatment of Complex Intertrochanteric and Subtrochanteric Fractures with the Long Gamma Nail

Abstract

The surgical treatment of complex inter- and subtrochanteric fractures is difficult and a multitude of intra- and extramedullary devices are being used. Since 1992 the long gamma nail is the implant of choice at our level-1 trauma center. Over a period of seven years we treated sixty-seven consecutive patients with sixty-nine complex intertrochanteric or subtrochanteric fractures. In order to evaluate the clinical and radiological outcome we retrospectively reviewed fifty-nine of these patients with a mean follow up of twenty-four months (range: 6 to 72 months). We encountered no intra- or perioperative complication nor early or late infection. Clinical and radiological bony union was achieved at a mean of 4.3 months in all of the patients (range: 3-9 months), in 15 cases (25 %) the distal locking bolts were retrieved in order to enhance callus formation and remodelling as a planned secondary surgery. Five patients (8 %) needed no planned secondary surgery for problems related to the nailing technique. Two mechanical failures with breakage of the nail were encountered due to proximal varus malalignment, of which one was treated with exchange nailing and grafting and the other one by removal of the broken hardware, blade-plating and bone grafting. One fracture below a short long gamma nail was treated by exchange nailing and two patients with backing out of the distal interlocking bolts had them exchanged. The minimally invasive technique and simple application of the long gamma nail leads after a relatively short learning curve to a low percentage of complications in these difficult fractures. Due to its good biomechanical properties early mobilization and partial weight bearing even in patients with advanced osteoporosis is possible.