Abstract
Historically the fractures of the proximal femur have been a challenge for the orthopaedic
surgeon, because of the high number of hardware failures and the high mortality rate.
The social and medical importance of these fractures is increasing and will be higher
in the future because of the improved life expectancy and osteoporosis. The development
of new material as well as the design of new devices have improved the results of
treatment of this kind of fractures. Historically the plate was the treatment of choice
for this kind of fractures, but the high incidence of hardware failures and non-unions
led to the introduction of the Gamma nail which initiated a revolution in the concept
of treatment of this kind of fractures. The main treatment target is to restore the
functional capacity of the patient as soon as possible with the much higher mechanical
guarantees of the device in order to obtain the fracture consolidation. A review of
the medical literature has been done as well an evaluation of the two main concepts
of treatment: plate versus endomedullary nail. Both techniques are not without risks,
both have technical complications related to the technique. These complications can
be resolved with an adequate learning curve. The experience of the surgeon is important
to decrease these technical complications. Although it can lead to controversy about
the treatment type for the stable fractures of the EPF, almost all the authors accept
the endomedullary γ nail (Gamma nail) as the most adequate treatment of the unstable
fractures of the proximal femur extremity.
Key words
Proximal femur - intertrochanteric, subtrochanteric fracture - Gamma nail - sliding
hip screw - cut out
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Pablo de Lucas MD
Department of Cirugía Ortopedia y Traumatología · Hospital Ramón y Cajal · University
of Alcala de Henares
Cta de Colmenar s/n
28035 Madrid
Spain
Phone: +34/6 07 64 46 30
Fax: +34/9 16 23 65 29
Email: pdelucas@ctv.es
