Evaluation of the Functional and Clinical Outcome of Intramedullary Osteosynthesis with Gamma Nail in Treatment of Unstable Peritrochanteric Fractures

Abstract
Background: Peritrochanteric fractures of the femur rank among the most common fractures in elderly people. The Gamma Nail is one of the latest advances in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures.
Purpose: This paper is made to assess the Functional & clinical Outcome of closed intramedullary osteosynthesis with a gamma nail in the treatment of unstable peritrochanteric fractures.
Material and Methods: The study was based on a total of 30 patients surgically treated for unstable peritrochanteric femoral fracture by gamma nail fixation in the period between June/2012 till February/2014, including 10 males and 20 females with the mean age is 67.63 (range 50 to 81). The right side was affected in 16 patients and left side was affected in 14.
Results: There were 28 patients (93.33%) with good reductions while there was 2 cases with mild displacement (<8mm) in both AP & lateral views but considered accepted. The fracture had healed in all the patients with no significant varus displacement except in 2 patients where their fracture had healed with mild (<20) degrees varus angulations. No intraoperative complication were reported. Post operative fracture of femur midshaft had occurred in 1 patient after 10 weeks. Screw cutout had occurred also in 1 case while 3 cases sustained suerficial infection. Recovery situations of all patients were evaluated based on Harris scoring with an average of 87 points. There are indications and improved functional outcome in the treatment of unstable intertrochanter-ic fracture with Gamma 3 intramedullary nail.
Conclusion: Various studies found favorable results with gamma nail in managing a greater variety of unstable hip fractures with a less invasive technique and with better results. Other studies have reported favorable results with GN in terms of shorter operation time, less blood loss, shorter hospital stay, decreased wound infection and reduced complication rate.