GAMMA NA111NG fOR UNSTABlE SUBTROCHANITR1C fEMORAl FRACTURES

Abstract

We used the Gamma nail in the treatment of 24 unstable subtrochanteric fractures in 24 patients, including 18 males and 6 females, whose age ranged from 19 to 85 years with a mean of 47 years. The most frequent modes of trauma were fall from height and a fall at home. There were 3 pathological fractures and only one open fracture. Follow up ranged from 5-26 months with an average of 13 months. The average time to surgical interference was 8 days.

All patients were clinically assessed according to the Merle d'Aubigne hip scoring system. Our final results were excellent in 25 %, good in 45 %, fair in 13 % and poor in 17 %. Poor results occurred in two patients with pathological fracture. Radiologic assessment included union, malunion, failure of fixation and implant failure. There was only one case of delayed union and two non-united cases, with a union rate of 88 % at final follow up. Shortening and varus deformity occurred in two cases but had no effect on the clinical or functional outcome. Failure of fixation occurred in 2 cases but there were no implant failures. Also there were no intraoperative or postoperative shaft fractures.

From the above results, it can be seen that this implant may be used to treat unstable fractures of the subtrochanteric region. It can be considered a treatment alternative when the fracture pattern is complex and the bone is osteoporotic. The presence of the long gamma nail adds to the versatility of this implant, allowing its use even when there is long subtrochanteric extension or shaft involvement. Performing the procedure slowly and carefully, attending to every detail, and being warned of the possible complications are enough to allow the surgeon to fix the fracture and reach a satisfactory result.

The following are important considerations, which must always be put in mind:

• Pre-operative planning and measurement of the medullary canal, neck-shaft angle and a lateral view of the femur to detect abnormal curvature of femoral shaft.