Abstract

• Early operative treatment of peritrochanteric fracture in geriatric patients is now accepted practice and numerous versions of a sliding nail-plate system are the most widely used implants.
  The Gamma nail was introduced for the treatment of peritrochanteric component and minimizing the surgical trauma.
  We have operated 46 cases and studied 30 cases were followed up over 1 year.
  At follow-up, all patients continued to ambulate and all fractures healed. and clinical results was satisfactory. But we experienced some technical problems and complications.
  Intraoperative complications included difficulty in securely placing the distal screws(1 patient) and small fracture of the base of the greater trochanter(2 patients). Postoperative complications included gluteal bursitis(3 patients), progressive varus deformity(3 patients), progressive varus deformity(3 patients), thigh & knee pain(2 patients), cutting out of the femoral head (1 patient), and a femoral shaft fracture through the distal locking screws following a fall. We had no cases of infection or nonunion.
  To minimize technical problems and complications, the following considerations are important.
  1. Accurate preoperative templating is necessary.
  2. Exact placement of the guide wire. It must enter the greater trochanter at the junction of its anterior third and posterior two-thirds, just lateral to its tip.
  3. Selection of a nail 2mm narrower than the reamer was recommended.
  4. Nail must be inserted by hand, not by hammering, along the medulla canal.
  5. Lag screw must be inserted into femoral head deeply and avokd into superior part of head especially in severe porotic bone.
  6. Subtrochanteric fractures extending to distal locking site are inapproprocate indication for standard Gamma-nailing. a spiral subtrochanteric fracture which cannot be reduced by a closed technique is managed with circumferential wiring with nimimal incision before nail is inserted.
  7. Repeated check of device loosening is important, especially before distal locking screw insertion. Initial insertion of proximal part of distal screw is preferred and routine use of distal locking screws is prohibited.
  8. Weighted bearing must be delayed when abnormal sliding of lag screw is noted before weight bearing and in severe osteoporosis with comminution.
• Key words: Femur, Peritrochanteric fracture, Gamma nail

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