The standard Gamma nail: A critical analysis of 1,000 cases

Background: The continuous increase in the number of fractures of the proxi mal femur is directly attributable to the worldwide increase in life expect ancy. The standard version of the Gamma Interlocking-Nail (standard Gamma n ail [SGN], 200-mm length, 10-degree valgus curvature, two distal locking bo lts) was designed because of the demands in orthopedic hip surgery to devel op an implant stable enough to mobilize old patients as soon as possible to avoid further morbidity and mortality. Methods: Between the years 1992 and 1998, 1,000 consecutive patients with p eritrochanteric fractures were stabilized by using the SGN and included in this study. Special emphasis was given to the evaluation of the learning cu rve of the department of traumatology (not of single surgeons) and the infl uence of prognostic factors on the outcome of such operations. Results: The results of this study show that increasing "department experie nce" resulted in a reduction of the intraoperative complication rate by a f actor of 0.5 (p = 0.0001) per year. This means that even an inhomogeneous m ass of 78 surgeons can lower the rate of intraoperative complications by 50 % per year because of increased experience. The number of early postoperati ve complications annually decreased by a factor of 0.8 (p = 0.0042). Conclusion: Late postoperative complications correlate negatively with the patient's age (odds ratio, 0.9; p = 0.0001).