[Revision cause and effect of gamma nail fixation]

To investigate the reasons of failure of Gamma nail treatment for intertrochanteric fractures and define operative techniques of the revision surgery.

From January 1999 to January 2008, 20 cases of 432 patients treated with Gamma nails for intertrochanteric fractures were revised. There were 9 males and 11 females, aged 24-87 years (median 65 years). Among them, there were 4 cases of femoral shaft fracture, 2 cases of screw penetrating the femoral head, 11 cases of screw cutting out the femoral head and neck, 2 cases of internal rotation malformation, and 1 case of infection. The operative procedures of revision were as follows: 4 cases were treated with the long Gamma nail, 4 cases by adjusting the position of Gamma nail, 11 cases with artificial femoral head replacement, and 1 case by removing Gamma nail and debriding and re-implant the Gamma nail.

The hospitalization days were 16-28 days (21.2 days on average); the bleeding volume during operation was 150-600 mL (380 mL on average). All wounds healed by first intention. Bed rest days were 7-15 days (12.5 days on average). All the patients were followed up for 1-8 years (5 years on average). The operations were successful, the femoral intertrochanteric fracture and femoral shaft fracture reached bony union. Complications such as loosening, breakage of hardware and coxa adduct were not observed. No loosening and dislocation of the prosthesis occurred. Among the patients with complications, 9 patients were treated with a Gamma nail again. Fracture healing was achieved within 2 to 5 months, with an average of 3 months. According to the WANG Fang et al. criterion for hip joint function, the results were excellent in 7 cases and good in 2 cases. In 11 patients who received artificial femoral head replacement, the hip joint function restored to normal. Harris score was 90-93.

Various causes such as osteoporosis, tip-apex distance (> or =25 mm), femoral shaft malformation, Gamma nail shortcomings may lead to complications after Gamma nail treatment for intertrochanteric fractures. Good results will be achieved by different revision techniques.