With its lower complication rate in comparison with intramedullary nails, and absence of functional outcome data to the contrary, the SHS appears superior for trochanteric fractures. Further studies are required to confirm whether more recently developed designs of intramedullary nail avoid the complications of previous nails. Intramedullary nails may have advantages over fixed angle plates for subtrochanteric and some unstable trochanteric fractures, but further studies are required.
[Osteosynthesis of per- and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study].
To compare clinical and radiological results in per- and subtrochanteric fractures' management with 90 degrees blade plate or Gamma nail fixation; an implant allowing early weight-bearing and fracture healing in correct position remains still difficult.
                Between 1993 and 1995, 26 patients addressed to our Center for a Kyle IV [1] fracture were divided into 2 groups, one fixed with blade plate and the other with Gamma nail. The follow-up for all patients is 12 months.
                Gamma nail allows early weight-bearing in all patients, fracture healing is acquired at 4.2 months; an operative diaphyseal fracture needed conversion to a long Gamma nail. We observed a slight cut-out that didn't need reoperation. In the blade plate group, we noticed three femoral head necrosis without major flattening, two non-unions, one plate's breakage and two malunions; fracture healing is acquired at 6.3 months. The two non-unions and the plate's breakage didn't need reoperation because of low functional demand.
                We prefer Gamma nail in per- and subtrochanteric femoral fractures' management, it allows early and fast weight-bearing and fracture healing is acquired in all cases.