J Korean Fract Soc.  2009 Apr;22(2):85-90. 10.12671/jkfs.2009.22.2.85.

Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

• Kweon SH
• Chun CH
• Yang JH
• Park JY
• Bae KH

• KMID: 1470020
• DOI: http://doi.org/10.12671/jkfs.2009.22.2.85

Abstract

PURPOSE: We analyzed the complications of femoral peritrochanteric fractures treated with the Gamma nail to reduce its complications.
MATERIALS AND METHODS
We evaluated the complications among the 96 patients who were treated with the Gamma nail from January 2000 to May 2005. Mean follow-up period was 17.8 months and mean age was 75.2 years. We analysed the relationship between the complication and the fracture pattern, postoperative reduction status, position of the lag screw, bone density, displacement and tip-apex index (TAD).
RESULTS
The complications were presented in 12 cases (12.5%). Cut-out of lag screw were in 5 cases, varus deformity with short lag screw in 2 cases, metal breakage of distal screw in 1 case, breakage of drill bit intraoperatively in 1 case, superficial infection in 2 cases and deep infection in 1 case. 5 cases (4.2%) were required reoperation. All of the cut-out of lag screw showed increased TAD (tip apex distance) above 25 mm.
CONCLUSION
To reduce the complications of the Gamma nail, we need exact surgical technique, good positioning of the lag screw and choice of appropriate length for the lag screw.

Keyword

Peritrochanteric fracture; Gamma nail; Complication

MeSH Terms

Bone Screws
Congenital Abnormalities
Displacement (Psychology)
Follow-Up Studies
Humans
Isothiocyanates
Mandrillus
Nails
Reoperation
Isothiocyanates

Figure

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  Fig. 1 (A) Preoperative radiograph shows unstable intertrochanteric fracture of the femur. (B) Postoperative radiograph shows good reduction, but lag screw was being superior position. (C, D) Radiograph 13 months after operation showing a cut-out of the lag screw.

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  Fig. 2 (A) Initial radiograph shows reverse intertrochanteric fracture. (B) Postoperative radiograph shows nonanatomic reduction. (C) 13 month follow up, lag screw displaced backward and collapse, and varus deformity occurred.

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  Fig. 3 (A) Initial radiographs showed unstable intertrochanteric fracture. (B) Postoperative radiographs shows nonanatomical reduction with medial displacement. (C) The distal screw breakage was occurred after 17 month, but fracture was union.

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  Fig. 4 Lag screw position.

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