Complications associated with gamma nailing. A review of 439 cases

We have retrospectively analysed 439 peritrochanteric hip fractures treated in our institution using the Gamma nail, with attention focused on complications. Intraoperative complications were observed in 15 patients (3.4%), consisting mainly of fractures (1.8%). Out of 323 fractures (73.6%) followed until radiographic bone healing (mean follow-up of 10 months), 261 (80.8%) healed without a problem. There were 62 postoperative complications (19.2%) with 37 patients (11.5%) requiring additional surgical procedure. The two most frequent major complications were cut out of the cephalic screw (7.1%) and diaphyseal fractures (3.1%). Other complications included fracture collapse more than 2 cm (1.5%), infection (0.9%), delayed union (0.9%) with one case of nail breakage (0.3%) and persistent pain in 20 patients (6.2%). All intraoperative fractures, nearly all cases of postoperative cut out of the lag screw and some postoperative diaphyseal fractures can be related to technical errors. Strict observance of the operative technique can decrease per- and postoperative complications.