Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

Seok Hyun Kweon; Churl Hong Chun; Jung Hwan Yang; Jin Young Park; Kyu Hwan Bae

doi:10.12671/jkfs.2009.22.2.85

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Kweon, Chun, Yang, Park, and Bae: Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

Original Article

Journal of the Korean Fracture Society 2009; 22(2): 85-90.

Published online: 30 April 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.2.85

Complications of Femoral Peritrochanteric Fractures Treated with the Gamma Nail

Seok Hyun Kweon, M.D., Churl Hong Chun, M.D., Jung Hwan Yang, M.D., Jin Young Park, M.D., Kyu Hwan Bae, M.D.

Department of Orthopedic Surgery, School of Medicine, Wonkwang University, Iksan, Korea.

Address reprint requests to: Jung Hwan Yang, M.D. Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, 344-2, Shinyong-dong, Iksan 570-711, Korea. Tel: 82-63-859-1360, Fax: 82-63-852-9329, bakgom95@hanmail.net

Received 31 August 2008 Accepted 9 March 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We analyzed the complications of femoral peritrochanteric fractures treated with the Gamma nail to reduce its complications.

Materials and Methods

We evaluated the complications among the 96 patients who were treated with the Gamma nail from January 2000 to May 2005. Mean follow-up period was 17.8 months and mean age was 75.2 years. We analysed the relationship between the complication and the fracture pattern, postoperative reduction status, position of the lag screw, bone density, displacement and tip-apex index (TAD).

Results

The complications were presented in 12 cases (12.5%). Cut-out of lag screw were in 5 cases, varus deformity with short lag screw in 2 cases, metal breakage of distal screw in 1 case, breakage of drill bit intraoperatively in 1 case, superficial infection in 2 cases and deep infection in 1 case. 5 cases (4.2%) were required reoperation. All of the cut-out of lag screw showed increased TAD (tip apex distance) above 25 mm.

Conclusion

To reduce the complications of the Gamma nail, we need exact surgical technique, good positioning of the lag screw and choice of appropriate length for the lag screw.

Keywords: Peritrochanteric fracture, Gamma nail, Complication

Figures and Tables

Fig. 1

(A) Preoperative radiograph shows unstable intertrochanteric fracture of the femur.

(B) Postoperative radiograph shows good reduction, but lag screw was being superior position.

(C, D) Radiograph 13 months after operation showing a cut-out of the lag screw.

Fig. 2

(A) Initial radiograph shows reverse intertrochanteric fracture.

(B) Postoperative radiograph shows nonanatomic reduction.

(C) 13 month follow up, lag screw displaced backward and collapse, and varus deformity occurred.

Fig. 3

(A) Initial radiographs showed unstable intertrochanteric fracture.

(B) Postoperative radiographs shows nonanatomical reduction with medial displacement.

(C) The distal screw breakage was occurred after 17 month, but fracture was union.

Fig. 4

Lag screw position.

Table 1

Type of complication

^*Number of patient.

Table 2

Fracture pattern

^*Number of patient, ^†Complication case.

Table 3

Position of lag screw

^*Number of patient, ^†Complication case.

Table 4

Reduction state

^*Number of patient, ^†Complication case.

Table 5

Bone mineral density

^*Number of patient, ^†Complication case, ^‡Bone mineral density.

Table 6

Singh index

^*Number of patient, ^†Complication case.

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