Comparison of ender nails, dynamic hip screws, and gamma nails in the treatment of peritrochanteric femoral fractures

Three hundred seventy-six patients with peritrochanteric fractures treated over a 10-year period were reviewed. In 85 patients treated with Ender nail ing, the most frequent complications were leg shortening (34), external rot ation failure (21), and postoperative distal gliding of the nails (7). In 1 83 patients treated with dynamic hip screws or a 95 degrees condylar or a 1 30 degrees blade plate, 3 presented with infection, 5 wi th instability, an d 4 with femoral head necrosis. In 105 patients treated with Gamma nailing, the most serious complications were infections (3), inward rotation failur e (2), postoperative bleeding at the insertion site (2),and shaft fracture (1). Because of its inherent instability, Ender nailing is no longer used. The i mplantation technique for the dynamic hip screw is safer and simpler than t he various models of the ASIF blade plate. However, the dynamic hip screw h as been superseded by the Gamma nail because of its absolute stability. In the beginning, Gamma nailing was technically more demanding with a higher n umber of intraoperative complications. In this study, the number of malalig nments did not differ siginificantly between the dynamic hip screw (14) and the Gamma nail (11), but was high with Ender nailing (56).