Osteosynthesis and Trauma Care 2003; 11: 77-80
DOI: 10.1055/s-2003-42329
Femur

© Georg Thieme Verlag Stuttgart · New York

Operative Technical Errors and Complications in Use of Gamma Nail

C. Nila1 , I. Georgilas1 , M. Tzourbakis1 , E. Papadakis1 , H. Patsopoulos1 , A. Diamantopoulos1 , Z. Stavrou1
  • 1B' Orthopaedic Department, “Evangelismos” General Hospital, Athens, Greece
Further Information

Publication History

Publication Date:
24 September 2003 (online)

Abstract

The aim of this investigation was to figure out the sources of technical errors during the operation and the complications that may occur in the later course of treatment. Over the last three years, 136 patients were treated with the Gamma nail, 91 Trochanteric Gamma nails, 17 Standard Gamma nails and 28 Long Gamma nails. After an evaluation of clinical and radiographic data, we observed numerous intraoperative errors as follows: inadequate reduction of the fracture, incorrect entry point, malpositioned lag screw guide wire, incorrect choice of material, lag screw and distal screw problems. The complications noted postoperatively were: “cut out”, malunion, trochanteric and thigh pain, and distal screw failure. The technical errors mentioned above did not lead to failure of the osteosynthesis in the majority of the patients. In a small group, mobilization and weight bearing were delayed, in order not to jeopardize the treatment, or a revision procedure took place. In most of the cases, complications occurred because of poor technique and lack of experience. With adequate surgical technique and experience, the advantages of the Gamma nail increase as the complication rate diminishes.

References

  • 1 Anne A K, Ekeland A, Odegaard B. et al . Gamma nail vs compression screw for trochanteric femoral fractures.  Acta Orthop Scand. 1994;  65 127-130
  • 2 Boriani S, Bettelli G. Il chiodo gamma.  Chir Organi Mov. 1990;  75 67-70
  • 3 Boriani S. et al . Results of the multicentric Italian experience on the Gamma nail: a report of 648 cases.  Orthopedics. 1991;  14 1307-1314
  • 4 Bridle S H, Patel A D, Bircher M, Calbert P T. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw.  J Bone Joint Surg [Br]. 1991;  73 330-334
  • 5 Calvert P T. The Gamma nail - a significant advance or a passing fashion?.  J Bone Joint Surg [Br]. 1992;  74 329-331
  • 6 Curtis M S, Jinnah R H, Wilson V, Cunnigham B W. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation.  Injury. 1994;  25 99-104
  • 7 Davis J, Harris M B, DuVal M, D'Ambrosia R. Pertrochanteric fractures treated with the Gamma Nail: technique and report of early results.  Orthopedics. 1991;  14 939-942
  • 8 Lacroix H, Arwert H, Snijders C J, Fontijne W PJ. Prevention of fracture at the distal locking site of the gamma nail.  J Boint Joint Surg [Br]. 1995;  77 274-276
  • 9 Halder S C. The Gamma nail for peritrochanteric fractures.  J Bone Joint Surg [Br]. 1992;  74 340-349
  • 10 Heinz T, Vécsei V. Langzeitergebnisse bei der Anwendung des Gammanagels bei hüftgelenksnahen Frakturen.  Osteosynthese Int. 1993;  14 69-72
  • 11 Heinz T, Vécsei V. Complications and mistakes in using the Gamma nail - reasons and preventive measures.  Chirurg. 1994;  65 943-952
  • 12 Kempf I, Grosse A, Taglang G, Favreul E. Le clou gamma dans le traitment à foyer ferme des fractures trochanteriennes.  Rev Chir Orthop. 1993;  79 29-40
  • 13 Kukla C, Heinz T, Berger G, Kwasny O, Vécsei V, Rosenberger A. Gamma-nail versus dynamic hip screw in 120 elderly patients. A randomized trial.  Acta Chir Austriaca. 1997;  29 290-293
  • 14 Latta L L, Sarmiento A, Tarr R R. The rationale of functional bracing of fractures.  Clin Orthop. 1980;  146 28-36
  • 15 Lindsey R W, Teal P, Probe R A. et al . Early experience with the gamma interlocking nail for peritrochanteric fractures of the proximal femur.  J Trauma. 1991;  31 1649-1658
  • 16 Lyddon D W. The prevention of complications with the Gamma Locking Nail.  Am J Orthop. 1996;  25 729
  • 17 McKibbin B. The biology of fracture healing in long bones.  J Bone Joint Surg [Br]. 1992;  74 340-349
  • 18 Pagnani M J, Lyden J P. Postoperative femoral fracture after intramedullary fixation with a gamma nail: case report and review of literature.  Journal of Trauma. 1994;  37 133-137
  • 19 Parker M S, Pryor G A. Gamma versus DHS nailing for extracapsular femoral fractures. Meta analysis of ten randomized trials.  Int Orthop. 1996;  20 163-168
  • 20 Radford P J, Needoff M, Webb J K. A prospective randomized comparison of the dynamic hip screw and the gamma locking nail.  J Bone Joint Surg [Br]. 1993;  75 789-793
  • 21 Rosenblum S F, Zuckerman J D, Kummer F, Tam B S. A biomechanical evaluation of the gamma nail.  J Bone Joint Surg [Br]. 1992;  74 352-357
  • 22 Stapert J WJL, Dunki Jacobs P B, Vierhout P AM. et al .The gamma nail: pitfalls, complications and randomized studies. In: Marti RK, Dunki Jacobs PB (eds). Proximal Femoral Fractures. Operative Techniques and Complications. Vol 2, Medical Press Ltd, London 1993; 459- 474
  • 23 McConnell T. et al .Gluteus Medius Tendon Injury during Reaming for the Gamma Nail Insertion. OTA Boston Medical Center, Boston, MA 2000
  • 24 Van der Brink W A, Jansen I MC. Failure of the gamma nail in a highly unstable proximal femur fracture: report of four cases encountered in The Netherlands.  Journal of Orthopaedic Trauma. 1995;  1 53-56
  • 25 Williams W W, Parker B C. Complications associated with the use of the Gamma Nail.  Injury. 1992;  23 291-292
  • 26 Zafiropoulos G, Pratt D J. Fractured gamma nail.  Injury. 1994;  25 331-336

C. Nila M. D.

Orthopaedic Department

“Evangelismos” General Hospital

Ipsilantou 45-47

10676 Athens

Greece







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