Key result
The Gamma nail showed no difference in proximal fixation failure compared to the Dynamic Hip Screw (2 vs 3 cases), but was associated with four cases of femur fracture requiring major surgery.
Why the study?
Does the Gamma nail improve clinical outcomes or reduce complications compared to the Dynamic Hip Screw in elderly patients with intertrochanteric fractures of the proximal femur?
RCT (n=100)
Does the Gamma nail improve clinical outcomes or reduce complications compared to the Dynamic Hip Screw in elderly patients with intertrochanteric fractures of the proximal femur?
While the Gamma nail provides similar general outcomes to the Dynamic Hip Screw, it is associated with a concerning risk of secondary femur fractures requiring major surgery.
Gamma nail increases femoral fracture risk without reducing fixation failure; challenges its preference over Dynamic Hip Screw for intertrochanteric fractures.
We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients' mobility at final review. There was no difference in failure of proximal fixation: cut-out occurred in three cases with the DHS, and twice with the Gamma nail. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery. In the absence of these complications, union was seen by six months in both groups.
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Bridle et al. (1991) conducted an RCT in Intertrochanteric fractures of the proximal femur (n=100). Gamma nail vs. Dynamic Hip Screw (DHS) was evaluated on Failure of proximal fixation (cut-out). The Gamma nail showed no difference in proximal fixation failure compared to the Dynamic Hip Screw (2 vs 3 cases), but was associated with four cases of femur fracture requiring major surgery.
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