Journal of Musculoskeletal Trauma

Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures: Bing Zhe Huang, Yong Wook Park, Jin Su Park, Kyu Cheol Noh, Soung Yon Kim, Kook Jin Chung, Hong Kyun Kim, Hyong Nyun Kim, Yong Hyun Yoon, Ji Hyo Hwang; J Korean Fract Soc 2014;27(3):213-221. Published online July 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.3.213

PURPOSE
This study was conducted in order to demonstrate the radiologic and clinical results of using the Asian type gamma 3 nail in treatment of trochanteric fractures.
MATERIALS AND METHODS
Patients underwent operations with gamma 3 nails between August 2010 and August 2012. For the radiologic evaluation, we analyzed bone quality, fracture pattern, reduction quality, union period, and position of lag screw (tip-apex distance, Cleveland index). For the clinical evaluation, we analyzed mobility score of Palmer and Parker and Jensen's functional score.
RESULTS
The mean union was taken at 17.4 weeks (14-25 weeks). Two cases (4.3%) underwent reoperation due to cutting out of the hip screws. The clinical outcomes of Parker and Palmer's average mobility score changed from 7.3 to 5.8 (79%), Jensen's functional score was 1.3 to 1.8 (72%).
CONCLUSION
We achieved excellent clinical and radiological outcomes; therefore, Asian type gamma 3 nail is effective in treatment of trochanteric fractures of the femur in Korea.

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Clinical and radiological outcome of the Chimaera short nailing system in inter- and subtrochanteric fractures
Aurélien Traverso, Trieu-Hoai-Nam Ngo, Guillem Fernandez Gil, Xavier Lannes, Sylvain Steinmetz, Kevin Moerenhout
Injury.2023; 54(3): 970. CrossRef

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The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail: Jong Oh Kim, Young One Ko, Mi Hyun Song; J Korean Fract Soc 2011;24(1):1-6. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.1

Abstract PDF: PURPOSE
To evaluate the efficiency of additional fixation of the alternative bone substitute in unstable intertrochanteric fractures treated with gamma nail and alternative bone substitute and only with gamma nail.
MATERIALS AND METHODS
Radiologic comparison was done between forty-four patients of unstable intertrochanteric fracture (AO type A2.2, A2.3) during six months. The patients were divided into two groups, a group treated with gamma nail and alternative bone substitute (22 patients, group 1) and another group treated only with gamma nail (22 patients, group 2). Postoperative reduction status, Cleveland index, Tip-apex distance and complications during the follow-up period was compared. Lag screw slippage and femoral neck-shaft angle change were measured between two groups.
RESULTS
No significant difference of reduction status, Cleveland index and Tip-apex distance was found. In group II, there was a 1 more case of cutting-out of the lag screw, but also there was a significant difference. Lesser change in lag screw slippage and neck-shaft angle change was investigated.
CONCLUSION
As there are lesser lag screw slippage and neck-shaft angle change, alternative bone substitutes applied in unstable intertrochanteric fractures seems to be useful in maintaining reduction and preventing failure of internal fixation when proper reduction and screw insertion is performed.

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Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail: Seok Hyun Kweon, Churl Hong Chun, Jung Hwan Yang, Jin Young Park, Kyu Hwan Bae; J Korean Fract Soc 2009;22(2):85-90. Published online April 30, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.2.85

Abstract PDF

PURPOSE
We analyzed the complications of femoral peritrochanteric fractures treated with the Gamma nail to reduce its complications.
MATERIALS AND METHODS
We evaluated the complications among the 96 patients who were treated with the Gamma nail from January 2000 to May 2005. Mean follow-up period was 17.8 months and mean age was 75.2 years. We analysed the relationship between the complication and the fracture pattern, postoperative reduction status, position of the lag screw, bone density, displacement and tip-apex index (TAD).
RESULTS
The complications were presented in 12 cases (12.5%). Cut-out of lag screw were in 5 cases, varus deformity with short lag screw in 2 cases, metal breakage of distal screw in 1 case, breakage of drill bit intraoperatively in 1 case, superficial infection in 2 cases and deep infection in 1 case. 5 cases (4.2%) were required reoperation. All of the cut-out of lag screw showed increased TAD (tip apex distance) above 25 mm.
CONCLUSION
To reduce the complications of the Gamma nail, we need exact surgical technique, good positioning of the lag screw and choice of appropriate length for the lag screw.

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Effectiveness of the Valgus Reduction Technique in Treatment of Intertrochanteric Fractures Using Proximal Femoral Nail Antirotation
Ji-Kang Park, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Dong-Soo Kim, Kyoung-Jin Park, Byung-Ki Cho, Jung-Kwon Cha, Sang-Woo Kang
Journal of the Korean Orthopaedic Association.2013; 48(6): 441. CrossRef

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Classification and Treatment of Unstable Intertrochanteric Fracture according to the Existence of Posterior Fragment : Preliminary Report: Lih Wang, Sung Keun Shon, Kyu Yeol Lee, Chul Hong Kim, Myung Jin Lee, Chul Won Lee, Sung Soo Kim; J Korean Fract Soc 2008;21(2):110-116. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.110

Abstract PDF

PURPOSE
To predict the feature and stability of intertrochanteric fractures with posterior fragment using preoperative 3D computed tomography and to investigate the importance of the posterior fragment in treatment of unstable intertrochanteric fracture.
MATERIALS AND METHODS
15 cases of unstable fractures with posterior fragment which were treated with nail only between October 2006 to August 2007 were classified into 2 groups: study group (5 cases with cannulated screw fixation of posterior fragment) and control group (10 cases without cannulated screw fixation). The average difference of neck-shaft angle, neck screw sliding distance and the complications in the two groups were compared retrospectively after a follow up of at least 3 months.
RESULTS
The average difference of neck-shaft angle in study and control group was 3.8 and 7.5 degree (p>0.05), respectively. The average difference of neck screw sliding distance was 1.6 and 6.6 mm (p<0.05), respectively. Complication which required reoperation was not noted in study group and complications of 3 cases about neck screw lateral protrusion, proximal migration and Z-effect phenomenon were noted in control group.
CONCLUSION
The recognition and fixation of the posterior wall was found to be an important predictive factor in unstable intertrochanteric fracture treatment.

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Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures
Chetan Puram, Chetan Pradhan, Atul Patil, Vivek Sodhai, Parag Sancheti, Ashok Shyam
Injury.2017; 48: S72. CrossRef
Additional Fixations for Sliding Hip Screws in Treating Unstable Pertrochanteric Femoral Fractures (AO Type 31-A2): Short-Term Clinical Results
Su Hyun Cho, Soo Ho Lee, Hyung Lae Cho, Jung Hoei Ku, Jae Hyuk Choi, Alex J Lee
Clinics in Orthopedic Surgery.2011; 3(2): 107. CrossRef

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Nailing in the Patients with Intertrochanteric Fractures of the Femur: Comparision Gamma Nail and Proximal Femoral Nail: Sang Bong Ko, Myung Rae Cho, Tae Hoon Kim, Il Woong Chang; J Korean Fract Soc 2004;17(4):295-300. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.295

Abstract PDF

PURPOSE
To evaluate the clinical and radiologic results of the fracture fixation using the Proximal Femoral Nail (PFN) or Gamma nail in patient with the intertrochanteric fractures.
MATERIALS AND METHODS
From January 1999 to February 2002, we reviewed 63 patients of intertrochanteric fractures including 31 patients managed with Gamma nail and 32 patients with PFN. In variate analysis of age, the pattern and stability of fracture, bone density (Singh index), preoperative patient activity, there was no difference between two groups. We evaluated the operation time, blood loss, stable reduction rate and varus reduction rate as operation-related factors, and radiologically investigated union time, the frequency of delayed union and nonunion, failure of fixation, status of the fracture line and complications. Functional results were evaluated by the possibility of early ambulation, ambulation ability at last follow up, and the pre and postoperative difference of ambulatory ability.
RESULTS
Mean operation time was 103+/-40 minutes in Gamma nail group and 101+/-28 minutes in PFN group. It was not statistically significant (p=0.801). Even though intraoperative blood loss was less in PFN group, it was not significant (p=0.601). Postoperative stable reduction rate was 31% in Gamma nail group and 30% in PFN group (p=0.934), suggesting not significant. Postoperative varus reduction and impacted amount of the fracture line was not significant. Delayed union developed in one case of Gamma nail group and 2 cases of PFN group. Mean loss of ambulation ability was 1.28 grade in Gamma nail group and 0.86 grade in PFN group (p=0.383). Statistical analysis was performed with the use of Student T test and Chi-square test. Analyses resulting in a p value of <0.05 were considered to show significance.
CONCLUSION
Generally, the radiologic and clinical results of intertrochanteric fractures were comparable for the PFN group and Gamma nail group. Even though it was not statistically significant, PFN group had superior results in operation time and blood loss than Gamma nail group for the fixation of the patients with intertrochanteric fracture.

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Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Dae Jung Huh
Hip & Pelvis.2013; 25(1): 51. CrossRef
Hemiarthroplasty for Hip Fractures in Elderly Patients over 80 Years Old - Comparative Analysis between Femoral Neck Fracture and Intertrochanteric Fracture -
Chae-Hyun Lim, Young-Yool Chung, Jeong-Seok Kim, Chung-Young Kim
Hip & Pelvis.2013; 25(1): 44. CrossRef
Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteic Fractures in the Elderly
Byung-Hak Kim, Young-Yool Chung, Sung-Chang Ki, Dae-Hyun Yoon, Ji-Hoon Ryu
Journal of the Korean Orthopaedic Association.2011; 46(5): 399. CrossRef
Treatment of Intertrochanteric Fracture with Proximal Femoral Nail
Dae Joong Kim, Sung Chan Ki, Young Yool Chung
Journal of the Korean Fracture Society.2007; 20(1): 40. CrossRef

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Operative Treatment of the Femur Intertrochanteric Fracture Using the Gamma nail and the Compression Hip Screw: Ju O Kim, Jae Il Oh, Sang Moon Yoo, Han Ki Lim; J Korean Soc Fract 2001;14(2):166-173. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.166

Abstract PDF

PURPOSE
To compare and analyze the operative results of compression hip screw with those of gamma nail in the treatment of intertrochanteric fracture of femur.
MATERIALS AND METHODS
We performed retrospective analysis of intertrochanteric fracture of femur using the compression hip screws on 16 cases(stable 8 cases, unstable 8 cases) and compared the results with those of 21 cases(stable 5 cases, unstable 16 cases) of Gamma nail fixation. All the 37 cases were operated between April 1992 and May 1997 and followed for minimal 12 months. We permitted earlier weight bearing for the Gamma nail inserted group(1 week vs 3 weeks). We evaluated the operation time, bleeding amount, intraoperative and postoperative complications, bone union time, neck-shaft angle, and functional assessment by follow up radiographs and clinical results.
RESULTS
The average operation time was shorter in the Gamma nail group than in the compression hip screw group (97+/-23.3 compared with 117+/-35.9 minutes; p<0.05). The average amount of bleeding was lesser in the Gamma nail group than in the compression hip screw group (592 compared with 712 ml: p<0.05). The fracture union time and clinical function of two groups showed no statistically significant difference(p>0.05). During Gamma nail insertion, crack was developed in one femoral shaft which was united after bed rest and delayed weight bearing. Postoperative complications were coxa vara in 3 cases(1 case on Gamma nail, 2 cases on CHS) and cutting out of lag screw in 3 cases(1 case on Gamma nail, 2 cases on CHS), but showed no statistically significant difference between two groups(p=0.781).
CONCLUSION
Early weight bearing can be encouraged for the Gamma nail group and this seemed to be beneficial for the old patients. The Gamma nail fixation is considered as a useful method for the patients with intertrochanteric fracture if it is managed with proper technique.

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Treatment of Intertrochanteric Fractures Using Targon Proximal Femoral Nails
Il Ho Park, Jong Kyoung Won, Kye Young Han
Hip & Pelvis.2012; 24(2): 117. CrossRef

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Ambulatory Recovery after Fixation of Intertrochanteric Fracture with Gamma nail in the Elderly: Dong Kyu Shin, Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Sang Bong Go; J Korean Soc Fract 2000;13(4):771-778. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.771

Abstract PDF

PURPOSE
This study was performed to evaluate the ambulatory recovery after fixation of intertrochanteric fracture of elderly patients with Gamma nail and to analyze the factors to affect the recovery.
MATERIALS AND METHODS
we evaluated the ambulatory result of 64 cases of intertrochanteric fracure which were fixed with gamma nail and rehabilitated with early weight bearing protocol regardless of reduction state. We analysed the result with statisical method and tried to find the important factor for better ambulatory recovery.
RESULTS
Only 21 patients were able to recover to preinjured level of ambulation and mean loss of ambulation ability was 1.31 according to our evaluation protocol. Stastically the age and early weight bearing walking exercise was affecting factor for better recovery of ambulation and the rate of complication caused by early weight bearing was not significant.
CONCLUSION
Fixation with Gamma nail and early weight bearing rehabilitation protocol was good choice for elderly intertrochanteric fracture without the risk of major complication.

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Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents
Hong Man Cho, Kyujung Lee, Woongbae Min, Yong Suk Choi, Hyun Suk Lee, Hyoung Jin Mun, Hye Young Shim, Da Geon Lee, Mi Joung Yoo
Journal of Korean Medical Science.2016; 31(1): 89. CrossRef

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Use of Gamma Nail in Peritrochanteric Fractures of the femur : A comparative study of Asian-Pacific type with Standard-European type: Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Dong Kyu Shin, Young Joon Youn; J Korean Soc Fract 1999;12(4):786-791. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.786

Abstract PDF: PURPOSE
: The mismatch of the Standard Gammd nail(SU) in oriental people led to the modification of the delign of its femoral shaft component and use of the Asian-Pacific type(AP). We compared the clinical results of 2 groups of femoral peritrochanteric fractures treated with each type of Gamma nail.
MATERIALS and METHODS
: 65 cases of peritrochanteric fractures of the femur(AP 24 cases, SU 42 cases) were studied with regard to operation time, union time and complications. The cases in each group were similar in fracture pattern, degree of osteoporosis and time interval between trauma and operation.
RESULTS
There were no significant differencef between two groups in operation time, intraoperative blood loss, and union time. Lateral cortical fracture and nail breakage were not observed in AP group but lag screw cutout was more frequent in AP group(8%) than in SU group(2%), but other complications were similar in type and frequency between two groups.
CONCLUSION
: AP Camma nail showed somewhat improved matching with the configuration of Korean femora, but further modification of the design might be needed to solve remained problems such as nail protrusion above trochanter.

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The Gamma Mail for Subtrochanteric Fractures of the Femur: Suk Kang, Jung Soo Hwang, Phil Hyun Chung, Dong Ju Chae, Yong Bum Park, Han Chul Kim, Kyu Hwang Um, Jeong Yong Hong; J Korean Soc Fract 1998;11(1):159-167. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.159

Abstract PDF: The aubtrochanteric area is cortical bone which has a decreased blood supply and a serious communition after trauma. Large biomechanical stresses in the subtrochanteric area can lead to failure of fixation devices. Many fixation devices have been used to treat the fractures of subtochanter of the femur. The Gamma nail was introduced for the treatment of peritrochanteric fractures with the theoretical advantage of a load-shearing femoral component. We reviewed 15 patients of subtrochanteric fractures who were treated by use of the Gamma nail at Dongguk university hospital since March 1993. Results showed satisfactory fracture union with little loss of position, even in comminuted fractures. The patients had shorter convalescence and earlier weight bearing. Perioperative complications were few. We conclude that Gamma nail is effective in achieving good stabilization of the unstable fractures of the subtrochanteric region and is an advance in the treatment of subtrochanteric fractures of the femur.

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Treatment of Intertrochanteric Fracture with Gamma Nail: Jung Dae Oh, Young Shik Lee, Shin Kang Cho, Jin Tae Choi; J Korean Soc Fract 1996;9(3):533-540. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.533

Abstract PDF: There are many problems in the treatment of the intertrochanteric fracture due to osteoporosis and unstable patten of fracture in elderly patients, which are also determined by quality of the bone, geometry and reduction of the fragments, and type and placements of the implant. The Gamma nail has recently become available for the treatment of intertrochanteric femur fracture. The authors analysed the intertrochanteric fracture of the 33 patients who were operatively treated with Gamma nail and followed up more than 3 years from May, 1991 to June, 1994 to evaluate the results and prognostic factors. The results obtained were as follws; 1. Type III in TronBo classification was the most common(58%). 2. Among the 33 cases, the patients with osteoporosis below grade III of Singh index were 26 cases(78.8%). In osteoporotic group(Singh index I-III), unstable type fracture was more common(85%). 3. The complication was developed in 8 cases(24.2%), of which cutting out from the femoral head was found in 4 cases. 4. The complication rate statistically had significant correlation with severity of osteoporosis.

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Clinical Application of Gamma Nail: Il Yong Choi, Kwang Hyun Lee, Chung Kyu Choi; J Korean Soc Fract 1996;9(2):489-495. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.489

Abstract PDF: The Gamma nail combining the advantages of a sliding lag screw and the intramedullary femoral fixation is a advance in the treatment of trochanteric fractures. The Gamma nail is a new intramedullary device which has been applied in treatment of the trochanteric fractures with the benefits of closed technique such as low blood loss, low risk of infection, short operative time, short bone union period and early weight bearing and with the biomechanical advantages such as short lever arm and decreased bending moment. The implant can be used by the method of static or dynamic. Intraoperative compression of the fracture segments can be achieved by acting on the sliding lag screw and further compression is given by weight bearing. We studied 31 cases of patients who had the trochanteric fractures and treated opratively with Camma nail. The intertrochanteric fracture was 25 cases and subtrochanteric fracture was 6 cases. Intraoperative complication was encountered failure of distal locking in 1 case. Postoperative complications were encounted superior cutting-out in 3 cases. As results of postoperative ambulation, 4 cases were death, 4 cases were bedridden state, 4 cases were ambulation state within house, 19 cases were social activity respectively.

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The Gamma Nail for Unstable Peritrochanteric Fractures: Hong Jun Han, Hee Jun Yu; J Korean Soc Fract 1996;9(1):76-80. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.76

Abstract PDF

The Gamma nail was designed to treat unstable intertrochanteric and subtochanteric fractures with the theoretical advantages of a load-sharing compinent which could be implanted by a semi-closed procedure. We report a retrospective study of 27 unstable peritrochanteric fractures treated by the Gamma nail. Gamma nail were implanted with an average duration of anesthesia of 84 minutes and little intra-operative bleeding by a semi-closed technique. Complications were few, and clinically not implant except one case of femoral shaft fracture at the distal end of the nail which healed well fter treatment with Gamma nail and circlage wiring.

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Treatment of the Proximal Femoral Fractures with Proximal Femoral Nail Antirotation (PFNA)
Myung-Sik Park, Young-Jin Lim, Young-Sin Kim, Kyu-Hyung Kim, Hong-Man Cho
Journal of the Korean Fracture Society.2009; 22(2): 91. CrossRef
Treatment of Senile Osteoporotic Intertrochanteric Fracture using Proximal Femoral Nail
Dong-Hui Kim, Sang-Hong Lee, Young-Lae Moon, Jun-Young Lee, Kun-Sang Song
Journal of the Korean Fracture Society.2007; 20(3): 215. CrossRef

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A Comparison study of the Gamma nail and the Dynamic Hip Screw for Peritrochanteric Fractures: Dong Chul Lee, Sang Jae Lee; J Korean Soc Fract 1994;7(2):616-627. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.616

Abstract PDF

The peritrochanteric fractures had been very troublesome due to its complication in the treatment of the old patients in the pastdays. The Dynamic Hip Screw and the Gamma nail made the patients to mobilize early and decreased the complications. We have treated 44 cases of the peritrochanteric fractures using Gamma nail(25 cases) and Dynamic Hip Screw (19 cases) between Aug. 1989 and Nov 1993, and compared the results of each group. And obtained results were as follows 1. The traffic accident was constituted about one third proportion and unstable types of the peritrochanteric fractures were 25 cases among 44 cases(57%). 2. The Mean union time of the Gamma nail group was 10.4 weeks and the Dynamic Hip Screw group was about 13 weeks. There was statistically no significance in the mean union time between both groups. 3. There revealed significance(P<0.05) by statistical analysis in operation time, admission day, blood transfusion between both groups. 4. There revealed no signicance (p<0.05) by statistical analysis in degree of sliding of the lag screw and change of neck-shaft angle. 5. The complications in the Gamma nail group were varus in 3 cases and infection in 1 case, and in the Dynamic Hip Screw group there were varus in 3 cases, delayed union in 2 cases and refracture in 1 case.

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The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail
Jong-Oh Kim, Young-One Ko, Mi-Hyun Song
Journal of the Korean Fracture Society.2011; 24(1): 1. CrossRef

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Treatment of Intertrochanteric Fractures using Gamma Nail: Joo Chul Ihn, Byung Chul Park, Sin Yoon Kim, Hyung Soo Ahn; J Korean Soc Fract 1994;7(2):588-596. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.588

Abstract PDF

Surgical fixation, early weight bearing and bony union remain a challange in the treatment of intertrochanteric femur fractures, especially if the fractures are comminuted or unstable. We have experienced 18 cases of intertrochanteric femur fracture that were treated using Asian Gamma nails(Gamma AP) in Kyungpook National University Hospital in period from Feb. 1993 to Oct. 1993. Early full weight bearing was encouraged and this seemed to be beneficial for old patients. All fractures were healed securely and many patients(15/18) could be painless ambulatory regardless of fracture configuration(9 fractures classified as unstable). Major complications included screw cut-out(2 cases), lateral cortical fracture(1 cases) and delayed union(1 case). In this early experience, the Gamma nail appears to be useful internal fixator for intertrochanteric femur fractures and it allows early ambulation regardless of the fracture configuration with excellent clinical results.

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Surgical Treatment of Femoral Unstable Intertrochanteric Fractures in Elderly Patients -Comparative Study between Compressive Hip Screws and Additional Trochanteric Stabilizing Plates-
Kap Jung Kim, Dae Suk Yang, Sang Ki Lee, Won Sik Choy, Kyoung Wan Bae
Journal of the Korean Fracture Society.2011; 24(4): 295. CrossRef
Comparison between Results of Internal Fixation and Hemiarthroplasty in Unstable Intertrochanter Fracture of Osteoporotic Bone
Haw Jae Jung, Jae Yeol Choi, Hun Kyu Shin, Eugene Kim, Se-Jin Park, Yong Taek Lee, Gwang-Sin Kim, Jong-Min Kim
Journal of the Korean Fracture Society.2007; 20(4): 291. CrossRef

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Treatment of Intertrochanteric Fractures using Gamma Nail: Joo Chul Ihn, Byung Chul Park, Sin Yoon Kim, Hyung Soo Ahn; J Korean Soc Fract 1994;7(2):580-587. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.580

Abstract PDF: Surgical fixation, early weight bearing and bony union remain a challange in the treatment of intertrochanteric femur fractures, especially if the fractures are comminuted or unstable. We have experienced 18 cases of intertrochanteric femur fracture that were treated using Asian Gamma nails(Gamma AP) in Kyungpook National University Hospital in period from Feb. 1993 to Oct. 1993. Early full weight bearing was encouraged and this seemed to be beneficial for old patients. All fractures were healed securely and many patients(15/18) could be painless ambulatory regardless of fracture configuration(9 fractures classified as unstable). Major complications included screw cut-out(2 cases), lateral cortical fracture(1 cases) and delayed union(1 case). In this early experience, the Gamma nail appears to be useful internal fixator for intertrochanteric femur fractures and it allows early ambulation regardless of the fracture configuration with excellent clinical results.

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A Comparison study of the Gamma Nail the Dynamic Hip Screw for Peritrochanteric Fractures: Jong In Im, Bu Hwan Kim, Gi Deug Lee; J Korean Soc Fract 1994;7(2):322-330. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.322

Abstract PDF: Early operative treatment of peritrochanteric fracture in geriatric patients is now accepted practice and numerous versions of a sliding nail-plate system are the most widely used implants. The Gamma nail was introduced for the treatment of peritrochanteric component and minimizing the surgical trauma. We have operated 46 cases and studied 30 cases were followed up over 1 year. At follow-up, all patients continued to ambulate and all fractures healed. and clinical results was satisfactory. But we experienced some technical problems and complications. Intraoperative complications included difficulty in securely placing the distal screws(1 patient) and small fracture of the base of the greater trochanter(2 patients). Postoperative complications included gluteal bursitis(3 patients), progressive varus deformity(3 patients), progressive varus deformity(3 patients), thigh & knee pain(2 patients), cutting out of the femoral head (1 patient), and a femoral shaft fracture through the distal locking screws following a fall. We had no cases of infection or nonunion. To minimize technical problems and complications, the following considerations are important. 1. Accurate preoperative templating is necessary. 2. Exact placement of the guide wire. It must enter the greater trochanter at the junction of its anterior third and posterior two-thirds, just lateral to its tip. 3. Selection of a nail 2mm narrower than the reamer was recommended. 4. Nail must be inserted by hand, not by hammering, along the medulla canal. 5. Lag screw must be inserted into femoral head deeply and avokd into superior part of head especially in severe porotic bone. 6. Subtrochanteric fractures extending to distal locking site are inapproprocate indication for standard Gamma-nailing. a spiral subtrochanteric fracture which cannot be reduced by a closed technique is managed with circumferential wiring with nimimal incision before nail is inserted. 7. Repeated check of device loosening is important, especially before distal locking screw insertion. Initial insertion of proximal part of distal screw is preferred and routine use of distal locking screws is prohibited. 8. Weighted bearing must be delayed when abnormal sliding of lag screw is noted before weight bearing and in severe osteoporosis with comminution.

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