INTRAMEDULLARY FIXATION OF HIGH SUBTROCHANTERIC FEMORAL FRACTURES - ASTUDY COMPARING 2 IMPLANT DESIGNS, THE GAMMA-NAIL AND THE INTRAMEDULLARY HIP SCREW

Objective: To compare two implants, the Gamma nail and the intramedull ary hip screw (IMHS(R)), in the treatment of high subtrochanteric femo ral fractures. Study Design: Prospective, nonrandomized clinical study . Methods: Eighty-seven consecutive patients with high subtrochanteric fractures of the Russell-Taylor Types 1A and 1B were treated with int ramedullary fixation. The first fifty patients were treated with the G amma nail and the next thirty-seven with the IMHS. The results of thes e operations were evaluated after a minimum follow-up of twelve months , and special emphasis was put on the complication rate. Results: The number of noninfectious complications (intraoperative fractures, posto perative refractures and fixation failures)was significantly higher (p = 0.037) in the Gamma group (11 of 50, 22 percent) than in the IMHS g roup (2 of 37, 5 percent). The complication most often associated with the Gamma nail, postoperative fracture of the femoral shaft (six in o ur Gamma group), was not encountered with the use of the IMHS. The Gam ma group also included three cases of intraoperative trochanteric exte nsion of the fracture versus none in the IMHS group. The IMHS group in cluded two mechanical fixation failures. Conclusions: The lower compli cation rate associated with the use of the IMHS implant could be attri butable in part to the learning curve in the use of intramedullary imp lants. However, we consider that the evolution of the implant design c ontributes to the result.