Intertrochanteric fractures of the femur: a randomized prospective comparison of the Gamma nail and the Ambi hip screw.
BACKGROUND
The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented.


METHODS
A prospective randomized study was used to compare the Ambi hip screw and the Gamma nail for the treatment of 69 patients over the age of 50 years with intertrochanteric femoral fractures. The groups were similar with respect to age, sex, prefracture mobility and abode, anaesthetic risk grade, CT measured bone density and fracture pattern.


RESULTS
Those treated with the Gamma nail had a significantly longer image intensifier screening time (P < 0.05), greater blood loss (P < 0.01) and more operative complications. There was no difference in the length of hospital stay but the level of mobility recovered was significantly better in the Ambi group at 6 months follow up. Urine retention was the most frequent complication but did not correlate with the implant or method of anaesthesia. Two implants cut out, one in each group. Limb shortening was similar in both groups and was not affected by leaving the Gamma nail unlocked distally in unstable fractures. Thirteen patients died from pre-existing medical conditions.


CONCLUSIONS
The Gamma nail proved technically more demanding with higher intra-operative complications and inferior return of mobility.
Hoffman
C W
CW
Orthopaedic Department, Taranaki Base Hospital, New Plymouth, New Zealand.
Lynskey
T G
TG
D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015519:Bone Density; D001858:Bone Nails / Q000009:adverse effects; D001863:Bone Screws / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007870:Leg Length Inequality / Q000209:etiology; D007902:Length of Stay; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016055:Urinary Retention / Q000209:etiology; D014963:X-Ray Intensifying Screens