The long Gamma nail: indications, technique and results

The introduction of the Gamma nail (GN) as an intramedullar implant for per trochanteric femoral fractures that allowed full weight bearing decreased t he death rate from 17 % (methods without full weight bearing) to 6 %. The l ong Gamma nail (LGN) is a logical supplement of the standard version, desig ned to treat unstable per-, subtrochanteric and segmental fractures. This s tudy evaluated 44 consecutive operations. Seventy percent of the patients h ad to be classified ASA III and IV, due to their high morbidity. The median age was 73.5 years. Multiple injuries occured in 30.2 %. All fractures wer e considered unstable. Surgery was usually performed within 24 h. The media n duration of the surgical treatment was 120 min. In five cases technical p roblems were observed. Radiological controls showed a good positioning of t he head screw. Early complications consisted of four local wound infections , three of them deep infections with a osteomyelitis. Deep venous thrombosi s was observed in four cases, two of which included a pulmonary embolism (c onservative treatment). The 30-day death toll was 2.3 % (one patient). The median survival time (using Kaplan-Meier) in the study was 46 months, compa red to 80 months in a matched population. This difference has to be linked to high premorbidity. The median duration of admission was 15 days. Mobilis ation with full weight bearing was theoretically possible in all cases, but additional injuries or preoperatively impaired walking ability prevented f ull mobilisation in 15 cases. Functional assessment uncovered a decrease in Merle d,Aubigne score of 26.7 % due to an impaired walking ability. Sevent y-three percent of the patients regained their preoperative social status. In conclusion the long Gamma nail is a universal. less invasive implant wit h high early weight bearing. It thus allows early remobilisation and reduce s lethality in the treatment of complex, unstable coral fractures.