OTA 1997 Posters - Hip Fractures

Gamma Nailing: Critical View and Pitfalls in 800 Cases

Christian Kukla, MD, Thomas Heinz, MD, Manfred Greitbauer, MD, Christian Gaebler, MD, Vilmos Vecsei, MD, Prof.

Vienna Medical School, Vienna, Austria

Purpose: Fractures of the coxal region of the femur are serious injuries, especially in the elderly. As the life expectancy of the population increases, trauma centers are being faced with a rising case load in increasingly elderly patients. The problem is compounded by a shortage of suitable facilities for the care and rehabilitation of these frail and demanding patients. This study points out the pros and cons of the 200 mm GN.

Material and Methods: We report 800 patients with proximal femoral fractures, classified according to the "Journal of Orthopaedic Trauma's Fracture and Dislocation Compendium" operated with the short gamma nail (GN, 200mm) in a time period of 4 years. We found 81% multifragmentary or unstable fractures. The mean age was 81 years (range 27 - 100) at the time of surgery; the sex ratio was 4:1 (female: male). 94% patients were operated within 24 hours, in 88% spinal anaesthesia took place.

Results: Operative intervention was compounded in 7% by faulty interlocking procedures due to a mismatch of the targeting device, 2% were followed by a shaft fracture with consecutive implantation of the longer version of the GN. Four percent cases of deep wound infection had to be revised operatively, 2 of them ended up in a girdlestone situation after removal of the implant. All patients reached bony healing within 3 months after operation while early full weight bearing was possible in each case.

Discussion: After facing a longer time period to overcome the difficulties of the learning curve we think that the device allies the biomechanical advantages of an intramedullary nail to the benefits of a semiclosed procedure, minimizing surgical trauma compared to other implants. The 200 mm GN permits very early full weight bearing regardless of fracture pattern. Unless complications are possible, the GN, in our opinion, is the standard technique for treatment of proximal femoral fractures, especially of the unstable type.