Abstract

The authors treat inter- and subtrochanteric fractures with the Gamma nail. This device, which can be placed through the skin, immediately gives a stable internal fixation and offers possibilities of compression during and after surgery without any risk of head perforation. The authors discuss the results and complications of 92 operated cases reassessed after a delay of 6 to 28 months. The average age was 78 years, and 95% of the patients had been injured in home accidents. The surgical technique must be strict. Weight-bearing is complete 48 hours postoperatively, whatever the type of fracture, in 82% of the patients. Early standing postoperatively has allowed a definitive reduction in the general complications which are otherwise frequent in this type of fracture. The authors analyze the various complications they experienced during and after the surgery. Six complications during surgery have been noted and result from technical errors. These include 4 diaphyseal fractures, one case of reamer breakage and one case of drill breakage. Thirteen complications occurred after surgery: 3 diaphyseal fractures, 3 loose screws, one pseudarthrosis and 6 painful diaphyses. The authors also noted that painful diaphysis occurs when the cervical diaphysis angle of the nail is greater than 130 degrees.