J Korean Hip Soc.  2011 Jun;23(2):124-130. 10.5371/jkhs.2011.23.2.124.

Comparison of the Gamma Nail and the Dynamic Hip Screw for Peritrochanteric Fracture

• Kweon SH

• KMID: 2190723
• DOI: http://doi.org/10.5371/jkhs.2011.23.2.124

Abstract

PURPOSE
To retrospectively compare the clincal and radiological results between the gamma nail and dynamic hip screw (DHS) on the operative treatment of unstable peritrochanteric fractures.
MATERIALS AND METHODS
From January 1999 to December 2006, we selected 215 patients who could be observed at least 1 year among 246 patients who received surgical treatment for unstable peritrochanteric fractures in our hospital. Eighty-six patients were males and 129 were females; the mean age was 72 years. Evans unstable fracture was included in our study. The gamma nail was applied in 133 cases, and the dynamic hip screw was applied in 82 cases. We evaluated union times, the collapse intensity of fractured sites after union, hospitalization duration, operation time, and post-operative complications.
RESULTS
The mean union time was 15.7 weeks with the DHS and 13.7 weeks with the gamma nail. The collapse intensity of fracture sites were 3.5 mm and 1.9 mm, respectively. The mean hospital durations were 19.5 days for DHS surgery and 16.3 days for gamma nail surgery. The mean operation time was 85.5 minutes for DHS and 98.2 minutes for gamma nail. The post-operative complications were loosening of internal fixator (6 cases in DHS, 1 case in gamma nail), perforation of the femoral head (2 cases in DHS, 1 case in gamma nail), and non-union (7 cases in DHS, 2 cases in gamma nail).
CONCLUSION
In unstable peritrochanteric fractures, biomechanically stable gamma nailing is thought to be one of the most effective treatments for reducing fracture site collapse and complications.

Keyword

Femur; Peritrochanteric fracture; Dynamic hip screw fixation; Gamma nailing

MeSH Terms

Femur
Head
Hip
Hospitalization
Humans
Internal Fixators
Male
Nails
Retrospective Studies

Figure

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  Fig. 1 (A) A 77-year old woman sustained unstable intertgrochanteric fracture. (B) Open reduction and innternal fixation with dynamic hip screws and plate. (C) Postoperative radiographs after 7 months shows metal loosening and collapsing of fracture line.

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  Fig. 2 (A) A 79-year old woman sustained unstable intertgrochanteric fracture. (B) Closed reduction and innternal fixation with Gamma nail. (C) Postoperative radiographs after 7 months shows the penetration of screw through the femoral head and reduction loss with varus deformity.

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