[Sub-trochanteric fractures. A comparative study between gamma nail and angular osteosynthesis with lateral cortical...

Treatment and outcome of sub-trochanteric fractures are at the origin of many problems. The aim of this study was to evaluate the superiority of the "Gamma Nail".

Two homogenous groups of patients were studied. Each group had 40 patients. The osteosynthesis performed in the first group (Group I) was an "angular" type with lateral cortical support (Nail plate, blade plate, dynamic screw). The second group (Group II) received the "Gamma Nail" implant. The 4 criteria employed to compare the 2 groups were: operatory (duration, blood loss, support-free walking); clinical (walking, pain, anatomy); radiological (reduction and healing); and finally complications and failures.

The average operative duration in group I was 3 hrs vs 1 hr in group II. 90 per cent of group I received transfusions with 3 bloods units vs 40 per cent of group II, received 1 blood unit. Support-free walking was authorized 3 months later in group I, and immediately in group II. The results were identical for clinical criteria. The average time for radiological bone healing was 3.5 months in group 1 and 2 months in Group II. 12 complications occurred in group I and 3 in group II: 7 cases of dismantling, 4 non unions and 1 serious deep infection in Group I. In group II: 2 cases of dismantling and a diaphysis fracture beneath the nail. These complications were found in the beginning of our experience with the Gamma Nail.

30 per cent of patients in Group I were affected by complications vs 7.5 per cent in group II (with p = 0.01). The duration of surgery, blood loss, and support-free walking delay demonstrated the superiority of the Gamma nail technique.

This study confirms the superiority of the Gamma nail for the treatment of sub-trochanteric fractures.