Importancia de la colocación del tornillo cefálico y de la distancia al apex en fracturas pertrocantéreas tratadas con clavo gamma

Pertrochanteric fractures are the most frequent type of proximal femur fractures. The main objectives of surgical treatment are early mobilization and full weight bearing. A good knowledge of the factors related to failure of the implant is necessary to avoid them. The most important is the cephalic screw positioning because it is most dependent is the cephalic screw positioning because it is most dependent on surgical technique. We present a retrospective study about the cephalic screws positioning in 400 pertrochanteric fractures treated with gamma nail. We also assessed the tip-apex distance and impaction of the fracture, looking for any relationships between them and the failure of the implant. In our series, 37.7% of screw failures occurs in the anterior-superior localization, and 30,7% in posterior-inferior localization. All cut-outs produced in cases with a Tipe Apex distance larger than 28 mm. The mean impaction in stable fractures as 2,27 mm and in unstable fractures was 8,26%.