The Long Gamma Nail for Solving Problems after Complications with the Standard Gamma Nail

Background:

The use of the standard Gamma nail in treating (sub)trochanteric fractures is associated with complications, especially fractures distal to the nail. No literature data is available concentrating on the solution of these problems. We studied if insertion of a long Gamma nail could offer an alternative.

Patients and Methods: A retrospective study in 20 hospitals throughout the Netherlands disclosed 53 patients in whom problems with the standard Gamma nail were solved by a long Gamma nail. Functional results and complications were assessed after a mean follow-up of 27 months.

Results: One patient died in hospital, and one was lost to follow-up. 40 patients (78%) regained complete mobility, ten (19%) partial mobility, and one patient (2%) remained bedridden. 49 patients (96%) felt no pain, and in two the pain was tolerable with minor analgesics. Two patients showed thromboembolic complications. In six patients perioperative complications occurred. One femur fractured distal to the nail after a fall. One lag screw migrated out of the head and nail. One femoral head necrosis was seen. Two deep infections were treated with antibiotics, in one low-grade infection the nail was removed after consolidation.

Conclusions: The long Gamma nail can properly redress the complications seen with the use of the standard Gamma nail. Problems with anchorage in the head and deep infections are limited. The functional results are good.