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.
A prospective comparative study of the compression hip screw and the gamma nail.
Achieving bony union and early weight bearing in peritrochanteric femur fractures poses a continuous challenge for the orthopedic surgeon. Current standards of surgical fixation for the myriad possible fracture patterns include the compression hip screw (CHS), the 90 degrees/95 degrees blade plate, and locked intramedullary nails. The gamma nail (GN) was designed as a "hybrid" of these devices, combining theoretical biomechanical advantages that should allow earlier postoperative weight bearing with surgical technique advantages that should decrease operative morbidity. Because these theoretical advantages were unproven in a clinical setting, we prospectively randomized 75 consecutive patients with peritrochanteric femur fractures into two groups to examine the fixation of these fractures with the GN as compared to the CHS. We found no significant differences in preoperative or intraoperative parameters. Postoperatively, the subtrochanteric fracture group treated with the GN achieved earlier weightbearing status, although this was not statistically significant. 72 patients were available for follow-up at a minimum of 6 months. All fractures had clinically and radiographically healed, and 94% of the patients continued to be ambulatory. Major complications included missed distal locking screws (one patient), cutting out of the lag screw superiorly in the femoral head (two patients), and a femur fracture at the distal end of the GN (one patient). In our series, the GN produced clinical results commensurate with current standards of fixation for peritrochanteric femur fractures. Although the GN allowed earlier independent weightbearing status in patients with subtrochanteric fractures, the procedure was technically more demanding and had a significant learning curve.