Gamma-nail nail breakage in the osteosynthesis of trochanteric femoral fractures

Abstract

Objective Mechanical breakage of the implant is a rare complication attributed to delayed fracture union or nonunion. This study presents a series of cases of breakage and secondary lag screw dislocation after cephalomedullary nailing. Material. Methods. In a retrospective study between 02/2005 and 12/2013 we analyzed all patients with trochanteric and subtrochanteric fracture who had been treated by cephalomedullary nailing. Fractures were classified according to AO/OTA classification. 13 patients with third generation Gamma nail failure were included. 7 patients were women, and 6 men with a mean age of 72 years (range 35-94). Results Important breakage occurred 6 month postoperatively (range 1-19 month). In 10 cases breakage was secondary to delayed or nonunion, which was thought to be mainly due to insufficient reduction of the fracture, wrong handling, incorrect drilling in the critical “red zone” (weak point of the nail around the insertion hole for the lag screw due to forces more than 1800 Newton), and in two cases due to loss of the lag screw because of missing set screw. In 1 case, breakage was apparent during elective metal removal following complete fracture healing. Short-term outcome was evaluated six months after operative revision using Harris Hip Score in 11 out of 13 patients showing a mean score of 84%. Complete radiological fracture healing has been found in 11 patients available for follow-up within 6 month after revision surgery. Conclusions Even though breakage of cephalomedullary nail osteosynthesis of trochanteric and sub trochanteric fracture is a severe complication, the result of our study demonstrate that revision surgery is warranted and provides good clinical and radiological short-term results.