Gamma Nail Fixation in Intertrochanteric Fractures: Pros and Cons

Dr. Ammar A. Salih Al-Kubaisi; Dr. Mohanad Hamid Hasan; Dr. Eid Mosleh Raheel

doi:10.31149/ijimm.v4i10.3012

Authors

Dr. Ammar A. Salih Al-Kubaisi M.B.Ch.B., C.A.B.M.S. \ (Orthopedic Surgery) Iraqi Ministry of Health, Al-Anbar Health Directorate, Al-Ramadi Teaching Hospital, Al-Anbar, Iraq.
Dr. Mohanad Hamid Hasan M.B.Ch.B., C.A.B.M.S. \ (Orthopedic Surgery) Iraqi Ministry of Health, Al-Anbar Health Directorate, Al-Ramadi Teaching Hospital, Al-Anbar, Iraq.
Dr. Eid Mosleh Raheel M.B.Ch.B., C.A.B.M.S. \ (Orthopedic Surgery) Iraqi Ministry of Health, Al-Anbar Health Directorate, Al-Ramadi Teaching Hospital, Al-Anbar, Iraq.

DOI:

https://doi.org/10.31149/ijimm.v4i10.3012

Keywords:

Intertrochanteric fracture, Gamma nail, intramedullary fixation, proximal femur, elderly patients, weight bearing, complications

Abstract

Background: Intertrochanteric fractures are common proximal femoral fractures in elderly patients, and their incidence is increasing. The aim of this study was to evaluate the advantages and pitfalls of Gamma nail (GN) fixation in these fractures. Methods: A prospective cross-sectional analytical study was carried out on 50 patients (30 men and 20 women, aged 45–80 years) with stable or unstable intertrochanteric fractures treated with a Gamma nail at Al-Ramadi Teaching Hospital, Al-Anbar, Iraq, between 1 July 2023 and 1 March 2024. Patients were followed up clinically and radiologically for at least three months. Results: The 66–70-year age group was the most affected. More than half of the patients had no comorbidity. Simple trauma was the commonest mechanism of injury (76%), and the left side was affected more often than the right. Most operations lasted less than one hour, fewer than five gauzes were used in 70% of cases, and fewer than 50 fluoroscopic shots were needed in 72%. Weight bearing began within three weeks in 84% of patients. Cut-through of the lag screw and varus malunion each occurred in 2% of patients, all with comorbidities, and no avascular necrosis was observed. Conclusion: Gamma nail fixation is a minimally invasive method with short operating time, little blood loss and early weight bearing, which makes it an appropriate treatment for elderly patients with intertrochanteric fractures.

References

[1] J. A. Kanis et al., “A systematic review of hip fracture incidence and probability of fracture worldwide,” Osteoporosis International, vol. 23, no. 9, pp. 2239–2256, 2012, doi: 10.1007/s00198-012-1964-3.

[2] E. M. Evans, “The treatment of trochanteric fractures of the femur,” The Journal of Bone and Joint Surgery. British Volume, vol. 31B, no. 2, pp. 190–203, 1949.

[3] M. Celiktas, E. Togrul, and O. Kose, “Calcar preservation arthroplasty for unstable intertrochanteric femoral fractures in the elderly,” Clinics in Orthopedic Surgery, vol. 7, no. 4, pp. 436–442, 2015, doi: 10.4055/cios.2015.7.4.436.

[4] L. Zhang et al., “Treatment of unstable intertrochanteric femoral fractures with locking gamma nail (LGN): A retrospective cohort study,” International Journal of Surgery, vol. 26, pp. 12–17, 2016, doi: 10.1016/j.ijsu.2015.12.064.

[5] W. T. Lee, D. Murphy, F. H. Kagda, and J. Thambiah, “Proximal femoral locking compression plate for proximal femoral fractures,” Journal of Orthopaedic Surgery, vol. 22, no. 3, pp. 287–293, 2014, doi: 10.1177/230949901402200304.

[6] J. A. Valverde et al., “Use of the Gamma nail in the treatment of fractures of the proximal femur,” Clinical Orthopaedics and Related Research, no. 350, pp. 56–61, 1998.

[7] T. Chen, K. Li, X. Wang, H. Lan, and J. Zhang, “Revision: Cause and effect of gamma nail fixation,” Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, vol. 24, no. 1, pp. 78–81, 2010 (in Chinese).

[8] J. O. Anglen and J. N. Weinstein, “Nail or plate fixation of intertrochanteric hip fractures: Changing pattern of practice. A review of the American Board of Orthopaedic Surgery database,” The Journal of Bone and Joint Surgery. American Volume, vol. 90, no. 4, pp. 700–707, 2008, doi: 10.2106/JBJS.G.00517.

[9] D. D. Bohl et al., “Extramedullary compared with intramedullary implants for intertrochanteric hip fractures: Thirty-day outcomes of 4432 procedures from the ACS NSQIP database,” The Journal of Bone and Joint Surgery. American Volume, vol. 96, no. 22, pp. 1871–1877, 2014, doi: 10.2106/JBJS.N.00041.

[10] J. Shen, C. Hu, S. Yu, K. Huang, and Z. Xie, “A meta-analysis of percutenous compression plate versus intramedullary nail for treatment of intertrochanteric hip fractures,” International Journal of Surgery, vol. 29, pp. 151–158, 2016, doi: 10.1016/j.ijsu.2016.03.065.

[11] M. R. Baumgaertner, S. L. Curtin, D. M. Lindskog, and J. M. Keggi, “The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip,” The Journal of Bone and Joint Surgery. American Volume, vol. 77, no. 7, pp. 1058–1064, 1995, doi: 10.2106/00004623-199507000-00012.

[12] H. W. Jones, P. Johnston, and M. Parker, “Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures,” International Orthopaedics, vol. 30, no. 2, pp. 69–78, 2006, doi: 10.1007/s00264-005-0028-0.

[13] M. Bhandari, E. Schemitsch, A. Jönsson, M. Zlowodzki, and G. J. Haidukewych, “Gamma nails revisited: Gamma nails versus compression hip screws in the management of intertrochanteric fractures of the hip: A meta-analysis,” Journal of Orthopaedic Trauma, vol. 23, no. 6, pp. 460–464, 2009, doi: 10.1097/BOT.0b013e318162f67f.

[14] Y. Gotfried, “The lateral trochanteric wall: A key element in the reconstruction of unstable pertrochanteric hip fractures,” Clinical Orthopaedics and Related Research, no. 425, pp. 82–86, 2004.

[15] M. Knobe, W. Drescher, N. Heussen, R. M. Sellei, and H.-C. Pape, “Is helical blade nailing superior to locked minimally invasive plating in unstable pertrochanteric fractures?” Clinical Orthopaedics and Related Research, vol. 470, no. 8, pp. 2302–2312, 2012, doi: 10.1007/s11999-012-2268-9.

[16] M. J. Parker and H. H. G. Handoll, “Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults,” Cochrane Database of Systematic Reviews, no. 9, Art. no. CD000093, 2010, doi: 10.1002/14651858.CD000093.pub5.

[17] G. J. Haidukewych, “Intertrochanteric fractures: Ten tips to improve results,” The Journal of Bone and Joint Surgery. American Volume, vol. 91, no. 3, pp. 712–719, 2009.

[18] M. W. Floyd, J. C. France, and D. F. Hubbard, “Early experience with the proximal femoral locking plate,” Orthopedics, vol. 36, no. 12, pp. e1488–e1494, 2013, doi: 10.3928/01477447-20131120-11.