Osteosynthesis and Trauma Care 2005; 13(3): 175-177
DOI: 10.1055/s-2005-836627
Original Article

© Georg Thieme Verlag Stuttgart · New York

Analysis of Complications and Results of Revision Surgeries after 1496 Gamma Nailings - A Multicenter Study

J. Nagy1 , S. Tompa1
  • 1Semmelweis Kórház KHT, Kiskunhalas, Hungary
Further Information

Publication History

Publication Date:
23 August 2005 (online)

Abstract

74 out of 1 496 patients (4.94 %) with intertrochanteric fractures operated with the Howmedica® Gamma nail underwent revision surgery due to complications. A retrospective analysis of these 74 cases is presented. Primary surgery was performed within 48 hours in 83 % of the cases. First choice of implant was the standard gamma nail. The nail was implanted after intramedullary reaming in 66 % and primary surgery was assessed as good to excellent in 66 %. Full weight bearing was achieved within 1 week in 40 % of patients. The head screw was in a cranial position in 30 %, the distance between the screw tip and the cortex of the femoral head was on average 6.16 mm (range: 1-20 mm). This was measured on antero-posterior radiographs. In 15 % (11 cases) cut-out was detected after 15.7 weeks (range: 2-55 weeks) postoperatively. Diaphyseal fractures at the nail tip were found in 12 %, rotational dislocation (more than 20°) in 8 %. Superficial wound infection was reported in 5.4 % (0.26 % of the total 1 496 cases) while deep infection occurred in 16.2 % (0.8 % of 1 496). Frequent methods of revision surgeries included change of nail (34 %) and prosthesis (11 %). After revision surgeries lethal complications were found in 11 %, after an average period of 3 months (range: 0.5-6 months).

References

  • 1 Boriani S, De Lure F, Betteli G, Specchia L, Bungaro P, Montanar G. et al . The results of a multicenter Italian study on the use of the Gamma nail for the treatment of pertrochanteric and subtrochanteric fractures: a review of 1 181 cases.  Chir Organt Mov. 1994;  79 193-203
  • 2 Boriani S, Risi M. Resultat einer italienischen Multi-Center-Studie über den Gebrauch des Gamma-Nagels bei der Behandlung von per- und subtrochanteren Frakturen: Überblick über 1 181 Fälle. In: Gahr RH et al. (Eds). Der Gamma Nagel - Standortbestimmung nach den ersten zehn Jahren. Einhorn Presse Verlag, Reinbek 1998; 342-348
  • 3 Eberle C. Die Schweizer Gamma-Nagel-Studie. In: Gahr RH et al. (Eds). Der Gamma Nagel - Standortbestimmung nach den ersten zehn Jahren. Einhorn Presse Verlag, Reinbek 1998; 349-351
  • 4 Halder S. The gamma nail for peritrochanteric fractures.  J Bone Joint Surg [Br]. 1992;  74 340-349
  • 5 Kukla C, Heinz T, Berger G, Kwasny O, Vécsei V, Rosemberg A. Gamma nail versus dynamic hip screw in 120 elderly patients. A randomized trial.  Acta Chir Austriaca. 1997;  29 290-293
  • 6 Kukla C, Heinz T, Gaebler C, Heinz G, Vécsei V. The standard Gamma nail: A critical analysis of 1 000 cases.  J Trauma Injury, Infection, Critical Care. 2001;  51 77-83
  • 7 Lindsey R W, Teal P, Probe R A, Rhoads D, Davenport S, Schauder K. Early experience with the Gamma interlocking nail for peritrochanteric fractures of the proximal femur.  J Trauma. 1991;  31 1649-1658
  • 8 McKibbin B. The biology of fracture healing in long bones.  J Bone Joint Surg [Br]. 1978;  60 150-162
  • 9 Merényi G, Kovács A, Zágh I. A gammaszegezéssel szerzett kezdeti tapasztalataink.  Magyar Traumatol Ortop Kézseb Plaszt Seb. 1994;  37 319-327
  • 10 Naumov I, Nyárády J. A trochantertáji sérülések kezelése gammszegezéssel, javallatok és eredmények.  Magyar Traumatol Ortop Kézseb Plaszt Seb. 1998;  4 307-312
  • 11 Naumov I, Nyárády J, Wiegand N. Per-és subtrochantericus femur törések, Megoldások és eredmények.  Magyar Traumatol Ortop Kézseb Plaszt Seb. 2002;  45 38-48
  • 12 Nila C, Georgilas I, Tzourbakis M, Papadakis E, Patsopoulos H, Diamantopoulos A, Stavrou Z. Operative technical errors and complications in use of Gamma nail.  Osteo Trauma Care. 2003 (Suppl 1);  11 S77-S80
  • 13 Rosenblum S F, Zuckermann J D, Kummer F, Tam B S. A biomechanical evaluation of the gamma nail.  J Bone Joint Surgery [Br]. 1992;  74 352-357
  • 14 Strasser E, Gahr R H. Deutsche Gamma-Nagel-Studie/Vorläufige Ergebnisse. In: Gahr RH et al. (Eds). Der Gamma Nagel - Standortbestimmung nach den ersten zehn Jahren. Einhorn Presse Verlag, Reinbek, 1998; 352-362
  • 15 Taglang G. Der TGN-Nagel (Trochanter-Gamma-Nagel). In: Gahr RH et al. (Eds). Der Gamma-Nagel - Standortbestimmung nach den ersten zehn Jahren. Einhorn Presse Verlag, Reinbek, 1998; 146-151

J. NagyM. D. 

Nemesszeghy M. u. 24

6000 Kecskemét

Hungary

Phone: +36/30/2 19 23 24, +36/77/52 20 00

Fax: +36/77/52 20 11

Email: korhaz@halasi-korhaz.hu

    >