Intertrochanteric-subtrochanteric fractures: Treatment with the long gammanail

Objective: To evaluate the outcome of the treatment of intertrochanteric-su btrochanteric fractures (subtrochanteric fractures with extension into the greater trochanter and the piriformis fossa) using the long Gamma nail. Design: Prospective, consecutive. Setting: Multicenter (private clinics). Patients: Fifty-two closed intertrochanteric-subtrochanteric fractures in n onpathologic bone in fifty-two consecutive patients with a mean age of fort y-five years (range, 18 to 91 years). Intervention: Closed reduction and internal fixation with the long Gamma na il. Main Outcome Measurements: Analysis of clinical and radiologic results with emphasis on the incidence of complications. Outcome assessment comparing t he preinjury status of every patient with the status at a minimum follow-up of twelve months. Results: At one year, seven patients had died and two other patients were l ost to follow-up. Thus, forty-three of the fifty-two patients completed a p rospective follow-up averaging sixteen months (range, 12 to 31 months). All fractures united within an avenge of 4.3 months (range, 3 to 6.5 months). Mechanical complications (breakage of the distal locking bolts) occurred in one fracture. Two patients had more than 5 degrees but less than 10 degree s of deformity in varus and more than one but less than 2.5 centimeters of shortening; two had mon than 5 degrees of deformity in varus; and two had u p to one centimeter of shortening. Two patients had other severe injuries t hat influenced the end result. Thirty-four of the remaining forty-one patie nts (82.9 percent) were restored to their preinjury status. There was no di rect relationship between the radiologic and the functional results: an exc ellent radiologic result was not uniformly associated with an excellent fun ctional outcome. Conclusions: Closed reduction and long Gamma nailing of intertrochanteric-s ubtrochanteric fractures enables the orthopaedic surgeon to treat these fra ctures with a minimally invasive procedure and a negligible rate of mechani cal complications. The rate of union was 100 percent in this series. The ra te of restitution to the preinjury status was high.