Complex fractures of the femur: treatment with a long gamma nail: short- and medium-term experience

The introduction of the gamma nail and of the long gamma nail, associating the principle of intramedullary nailing and of the sliding screw-plate, has led to good results in the treatment of complex fractures such as per-sub-trochanteric fractures and associated fractures of the femoral neck-diaphysis. In this study, our experience with the long gamma nail (Long Gamma Nail Howmedica) is presented. Of the 43 patients treated between 1993 and 1998, 21 (49%) with a mean follow-up of 2.5 years (1-5 years) were reviewed. Clinical and a radiographic evaluations were obtained for each of the patients. This study showed that there was a high incidence of poor consolidation (dysmetria in 10 patients, torsion deficit in 7, consolidation in varus of the femoral neck in 1 patient) particularly in associated fractures of the femoral neck and diaphysis, accompanied, however, by good functional recovery (only 3 patients with modification in the angle of progression of the foot) and by the satisfaction of the patients questioned. Thus, indications for the use of this device in proximal fractures of the femur, particularly in elderly patients and in high-energy traumas, are demonstrated.