Two groups of patients were treated for pertrochanteric fractures (AO/ASIF 31A1+A2) with an intramedullary hip nail. In the first group of 44 patients distal dynamic locking was used, and in the second group of 74 patients the nail was not distally locked. Comparison of the two groups of patients did not show any difference in terms of the period of fracture healing, radiological and functional results or frequency of complications. In the group with a distally locked nail the surgery took 40.4 minutes, while in the group without distal locking only 34.4 minutes. In total, we recorded only seven complications, none of which were caused by absence of distal locking of the nail. This study has shown that distal locking of IMHN is unnecessary in most pertrochanteric fractures (AO/ASIF 31A1+2). The only exceptions are comminution of the lateral wall of the greater trochanter, secondary diaphyseal fracture line, large posteromedial fragment extended distally below the level of the lesser trochanter and broad intramedullary canal.

Orthopaedic Department of 3rd Faculty of Medicine Charles University Srobárova 50 Prague 10 Czech Republic

See more in PubMed

Bartoníček J, Douša P, Krbec M. Short gamma nail for internal fixation of proximal femur fractures. Acta Chir Orthop Traum Cechoslov. 1998;65:74–83. PubMed

Bellabarba C, Herscovici D, Ricci WM. Percutaneous treatment of peritrochanteric fractures using the gamma nail. Clin Orthop Rel Res. 2000;375:30–42. doi: 10.1097/00003086-200006000-00005. PubMed DOI

Bridle SH, Patel AD, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomized prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg [Br] 1991;73-B:330–334. PubMed

Broos, PLO, van Haaften, KIK, Stappaerts et al (1989) Hip fractures in the elderly. Mortality, functional results and social readaptation. Int Surg 74:191–194 PubMed

Calvert PT. The gamma nail—a significant advance or a passing fashion? J Bone Joint Surg [Br] 1992;74-B:329–331. PubMed

Lucas P, Seral B, Beano Á, et al. Fractures of the proximal femur. The gamma nail versus plate. Osteo Trauma Care. 2005;13:18–25. doi: 10.1055/s-2005-836371. DOI

Douša P, Bartoníček J, Jehlička D, et al. Proximal femoral nail (PFN Synthes) for internal fixation of trochanteric fractures. Acta Chir Orthop Traum Cechoslov. 2002;69:22–30. PubMed

Halder SC. The gamma nail for peritrochanteric fractures. J Bone Joint Surg [Br] 1992;74-B:340–344. PubMed

Hardy DC, Descamps PY, Krallis P, et al. Use of intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. J Bone Joint Surg [Am] 1998;80-A:618–630. PubMed

Heinz T, Vécsei V. Komplikationen und Fehler bei der Anwendung des Gammanagels. Chirurg. 1994;65:943–952. PubMed

Herrera A, Domingo J, Martinez A. Results of osteosynthesis with the ITST nail in fractures of the trochanteric region of the femur. Int Orthop. 2008;32:767–772. doi: 10.1007/s00264-007-0411-0. PubMed DOI PMC

Hesse B, Gächter A. Complications following the treatment of trochanteric fractures with the Gamma nail. Arch Ortho Trauma Surg. 2004;124:692–698. doi: 10.1007/s00402-004-0744-8. PubMed DOI

Hohendorff B, Meyer P, Menezes D, et al. Behandlungsergebnisse und Komplikationen nach PFN-Osteosynthese. Unfallchirurg. 2005;108:938–953. doi: 10.1007/s00113-005-0962-8. PubMed DOI

Gadegone WM, Salphale YS. Proximal femoral nail—an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2007;31:403–408. doi: 10.1007/s00264-006-0170-3. PubMed DOI PMC

Klanke J, Franke J, Westermann K. The titanium gamma nail as routine treatment of pertrochanteric femoral fractures. Osteo Trauma Care. 2005;13:26–33. doi: 10.1055/s-2005-836372. DOI

Košťál R, Douša P, Bartoníček J. PFH (Proximální femorální hřeb) - Another possibility for internal fixation of trochanteric fractures. Rozhl Chir. 2003;82:28–31. PubMed

Lacroix H, Arwert H, Snijders CJ, et al. Prevention of fracture at the distal locking site of the gamma nail. J Bone Joint Surg [Br] 1995;77-B:274–276. PubMed

Leung KS, So WS, Shen WY, et al. Gamma nails and dynamic hip screw for pertrochanteric fractures. J Bone Joint Surg [Br] 1992;74-B:345–351. PubMed

Radford JP, Needorf M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg [Br] 1993;75-B:789–793. PubMed

Rosenblum SH, Zuckerman JD, Kummer FJ, et al. A mechanical evaluation of the gamma nail. J Bone Joint Surg [Br] 1992;74-B:352–357. PubMed

Saarenpää I, Heikkinen T, Ristiniemi J, et al. Functional comparison of the dynamic hip screw and the gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients. Int Orthop. 2009;33:255–260. doi: 10.1007/s00264-007-0458-y. PubMed DOI PMC

Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg [Br] 2004;86-B:86–94. PubMed

Shen WY. Complications with the gamma nail and long gamma nail, and their prevention. Osteo Trauma Care. 2005;13:34–41. doi: 10.1055/s-2005-836301. DOI

Utrilla AL, Reig JS, Muňoz FM, et al. Trochanteric gamma nail and compression hip screw for trochanteric fractures. J Orthop Trauma. 2005;19:229–233. doi: 10.1097/01.bot.0000151819.95075.ad. PubMed DOI

Valverde JA, Alonso MG, Porro JG, et al. Use of the gamma nail in the treatment of fractures of the proximal femur. Clin Orthop Rel Res. 1998;350:56–61. PubMed

CT analysis of femoral malrotation after intramedullary nailing of trochanteric fractures

The importance of intramedullary hip nail positioning during implantation for stable pertrochanteric fractures: biomechanical analysis