Intertrochanteric-subtrochanteric fractures: treatment with the long Gamma nail.
OBJECTIVE
To evaluate the outcome of the treatment of intertrochanteric-subtrochanteric fractures (subtrochanteric fractures with extension into the greater trochanter and the piriformis fossa) using the long Gamma nail.


METHODS
Prospective, consecutive.


METHODS
Multicenter (private clinics).


METHODS
Fifty-two closed intertrochanteric-subtrochanteric fractures in nonpathologic bone in fifty-two consecutive patients with a mean age of forty-five years (range, 18 to 91 years).


METHODS
Closed reduction and internal fixation with the long Gamma nail.


METHODS
Analysis of clinical and radiologic results with emphasis on the incidence of complications. Outcome assessment comparing the preinjury status of every patient with the status at a minimum follow-up of twelve months.


RESULTS
At one year, seven patients had died and two other patients were lost to follow-up. Thus, forty-three of the fifty-two patients completed a prospective follow-up averaging sixteen months (range, 12 to 31 months). All fractures united within an average of 4.3 months (range, 3 to 6.5 months). Mechanical complications (breakage of the distal locking bolts) occurred in one fracture. Two patients had more than 5 degrees but less than 10 degrees of deformity in varus and more than one but less than 2.5 centimeters of shortening; two had more than 5 degrees of deformity in varus; and two had up to one centimeter of shortening. Two patients had other severe injuries that influenced the end result. Thirty-four of the remaining forty-one patients (82.9 percent) were restored to their preinjury status. There was no direct relationship between the radiologic and the functional results: an excellent radiologic result was not uniformly associated with an excellent functional outcome.


CONCLUSIONS
Closed reduction and long Gamma nailing of intertrochanteric-subtrochanteric fractures enables the orthopaedic surgeon to treat these fractures with a minimally invasive procedure and a negligible rate of mechanical complications. The rate of union was 100 percent in this series. The rate of restitution to the preinjury status was high.
Center for Osteosynthesis, Asociación Española, Montevideo, Uruguay.
A
A
Barquet
L
L
Francescoli
D
D
Rienzi
L
L
López
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D017102:Fracture Healing / Q000502:physiology; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography