Fractured Gamma nail

Fractures of the trochanteric region of the femur are common in the elderly and their operative treatment is controversial. Many devices have been used surgically without any particular method being positively indicated. The sliding screw and plate method is currently the most widely used; the many other systems available include blade plates, flexible intramedullary rods (Enders or Harris) or intramedullary nails such as the Zickel, Kuntscher-Y, Williams-Y and Russell-Taylor reconstruction nail. More recently the Gamma nail has been introduced and many studies have been carried out to compare these various systems (Wolfgang et al., 1982; Carlson et al., 1984; Dobozi et al., 1986; Ruff and Lubbers, 1986; Henry et al., 1988; Wang et al., 1988; Simpson et al., 1989; Boziani and Betelli, 1990; Davis et al., 1990; Lechnez et al., 1990; Bridle et al., ‘1991; Chuan et al., 1991; Coleman et al., 1991). The most controversial of these fractures is that of the subtrochanteric which constitute 5-11 per cent of all fractures of the upper third of the femur and 26.7 per cent of all of those in the peritrochanteric region (Chi-Chuan et al., 1991). For these fractures the same range of devices is suggested together with conventional intramedullary interlocking or compression nails (Papagiannopoulos et al., 1989). One of the commonest is the Zickel nail but this has its own operative complications particularly fracture of the greater trochanter during its insertion (Wang et al., 1988; Calvert, 1992). This makes a number of surgeons sceptical about this technique although it appears to be the strongest in comparison with the Ender rod, the Kuntscher-Y or Harris nail (Carlson et al., 1984; Henry et al., 1988; Wainer et al., 1990). The complications of each device are different but it is well established that for subtrochanteric fractures the rate of non-union is quite high (Ruff and Lubbers, 1986). Subtrochanteric fractures create more problems being classed as unstable as they involve the lesser trochanter (Verghese and Jaffray, 1987) and mechanical failures of the implants are well documented (RL& and Lubbers, 1986; Davis et al., 1990). Davis et al. (1990) reviewed 20 such fractures (9 per cent of their total number of peritrochanteric fractures) and found implant failure in three cases (15 per cent of the subtrochanteric fractures) when using a sliding screw implant of a Kuntscher-Y nail.