Intertrochanteric-subtrochanteric fractures: treatment with the long Gamma nail

Abstract

Objective: To evaluate the outcome of the treatment of intertrochanteric-subtrochanteric fractures (subtrochanteric fractures with extension into the greater trochanter and the piriformis fossa) using the long Gamma nail.

Design: Prospective, consecutive.

Setting: Multicenter (private clinics).

Patients: Fifty-two closed intertrochanteric-subtrochanteric fractures in nonpathologic bone in fifty-two consecutive patients with a mean age of forty-five years (range, 18 to 91 years).

Intervention: Closed reduction and internal fixation with the long Gamma nail.

Main outcome measurements: Analysis of clinical and radiologic results with emphasis on the incidence of complications. Outcome assessment comparing the preinjury status of every patient with the status at a minimum follow-up of twelve months.

Results: At one year, seven patients had died and two other patients were lost to follow-up. Thus, forty-three of the fifty-two patients completed a prospective follow-up averaging sixteen months (range, 12 to 31 months). All fractures united within an average of 4.3 months (range, 3 to 6.5 months). Mechanical complications (breakage of the distal locking bolts) occurred in one fracture. Two patients had more than 5 degrees but less than 10 degrees of deformity in varus and more than one but less than 2.5 centimeters of shortening; two had more than 5 degrees of deformity in varus; and two had up to one centimeter of shortening. Two patients had other severe injuries that influenced the end result. Thirty-four of the remaining forty-one patients (82.9 percent) were restored to their preinjury status. There was no direct relationship between the radiologic and the functional results: an excellent radiologic result was not uniformly associated with an excellent functional outcome.

Conclusions: Closed reduction and long Gamma nailing of intertrochanteric-subtrochanteric fractures enables the orthopaedic surgeon to treat these fractures with a minimally invasive procedure and a negligible rate of mechanical complications. The rate of union was 100 percent in this series. The rate of restitution to the preinjury status was high.