[Complications and errors in use of the gamma nail. Causes and prevention]

The analysis of 310 cases of fractures of the femur, treated with a Gamma-nail osteosynthesis, done in two clinics for trauma surgery in Vienna, revealed to a high number of complications. For this reason we decided to start an evaluation aming at complications in connection to this type of treatment, with 440 patients treated over a five year period. We observed 148 complications, which will be described. The intraoperative failures were as follows: False drilling during the interlocking procedure 64, wrong length of lag screw 13, breakage of the drill bit during interlocking procedure 7, additional shattering of shaft 5, external malrotation of diaphysis (> or = 20 degrees) 6, internal malrotation of the diaphysis (> or = 20 degrees) 1, elongation of diaphysis (2 cm) 1, mistakes in using the proximal nail-plaque 4, breakage of bone elevator, used for reduction procedure 1 and 1 failure at the target-device during nailing. The complications during the postoperative treatment were: Infection 11, perforation of lag screw towards cranial 10, towards central 2, migration of the lack screw within the femoral head 7, diaphysial fracture at the distal end of nail 6, movement of interlocking bolts 4, osteolytic process at fracture site 2 and 3 haematomas, needing a revision. Most of these reported complications were due to technical failures, lack of experience or inadequate treatment modality. The specifications and descriptions should give information about the reasons of these complications, but it is the purpose of this publication too, to figure out the technical errors which were responsible for most of the complications described.