Outcomes of Gamma Nail Fixation for pertrochanteric fractures

Description: Archived 2003. UPMC. The introduction of the intramedullary hip screw (IMHS) was hailed as a solution for the treatment of complex intertrochanteric (IT) and subtrochanteric (ST) femur fractures. In fixation with the IMHS benefits of intramedullary shaft stabilization are combined with the advantages of sliding hip screw fixation. Fixation with the IMHS is in the canal versus on the lateral cortex with the Dynamic Hip Screw (DHS). This effect decreases the lever arm of the implant and reduces the bending strain on the implant. This biomechanical advantage enables more rigid fixation of complex fractures, and, thus, allows for earlier mobilization. The insertion technique of the IMHS also limits soft tissue disruption, which provides for a theoretical decreased blood loss and fewer problems with wound and fracture healing. One type of intramedullary sliding hip screw, the Gamma Nail (GN) (Howmedica, Rutherford, NJ) was first used in the U.S. in the late 1980ճ. Several studies indicated high rates of complications with use of the GN such as periprosthetic femur fracture (reported to range from 4% to 10%). Other anecdotal complications reported include intraoperative fracture, malunion, and lag screw cut out. The present observational study reports our experience with the GN for all surgeons at the authorճ institution.