Complications with the Gamma Nail and Long Gamma Nail, and Their Prevention

Abstract

While the Gamma nail is a relatively new device, the long Gamma nail, a very efficacious device for the treatment of unstable intertrochanteric and subtrochanteric fractures, is now available. Since, during the early phases of its use, various complications were reported, the nail itself has been modified, and the surgical technique has been adapted accordingly. Most complications are preventable, and complication rates decrease with increased experience. Surgeons who are new to the procedure should be thoroughly familiar with the technique and with the means to prevent complications.

Key words

Iatrogenic fractures - cut-out of sliding screw - pseudoaneurysm

References

• 1 Ahrengart L. et al . A randomized study of the compression hip screw and Gamma nail in 426 fractures.  Clin Orthop Related Research. 2002;  401 209-222
• 2 Alvarez J R, Gonzolez R C, Aranda R L, Blanco M F, Dehesa M C. Indications for use of the long Gamma nail.  Clin Orthop Related Research. 1998;  350 62-66
• 3 Barquet A, Francescoli L, Rienzi D, Lopez L. Intertrochanteric-subtrochanteric fractures: Treatment with the long Gamma nail.  J Orthopaedic Trauma. 2000;  14 324-328
• 4 Baumgaertner M R. et al . The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.  J Bone Joint Surg [Am]. 1995;  77 1058-1064
• 5 Baumgaertner M R, Solberg B D. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip.  J Bone Joint Surg [Br]. 1997;  79 969-971
• 6 Baumgaertner M R, Curtin S L, Lindskog D M. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures.  Clin Orthop Related Research. 1998;  348 87-94
• 7 Davis T R. et al . Intertrochanteric femoral fractures. Mechanical failure after internal fixation.  J Bone Joint Surg [Br]. 1990;  72 26-31
• 8 Den Hartog B D, Bartal E, Cooke F. Treatment of the unstable intertrochanteric fracture. Effect of the placement of the screw, its angle of insertion and osteotomy.  J Bone Joint Surg [Am]. 1991;  73 726-733
• 9 Kawaguchi S, Sawada K, Nabeta Y. Cutting-out of the lag screw after internal fixation with the Asiatic Gamma nail.  Injury. 1998;  29 47-53
• 10 Kukla C, Heinz T, Gaebler C, Heinze G, Vécsei V. The standard Gamma nail: A critical analysis of 1 000 cases.  J Trauma Injury, Infection and Critical Care. 2001;  51 77-83
• 11 Parker M J. Cutting-out of the dynamic hip screw related to its position.  J Bone Joint Surg [Br]. 1992;  74 625
• 12 Yang K H, Park H W, Park S J. Pseudoaneurysm of the superficial femoral artery after closed hip nailing with a Gamma nail: Report of a case.  J Orthopaedic Trauma. 2002;  16 124-127