The treatment of subtrochanteric nonunions with the long gamma nail: twenty-six patients with a minimum 2-year follow-up.
OBJECTIVE
To assess the efficacy of the long Gamma nail in the treatment of subtrochanteric nonunions.


METHODS
Retrospective.


METHODS
Multicenter (university teaching hospital, private centers).


METHODS
Twenty-nine consecutive patients with noninfected sub-trochanteric nonunions following fractures previously treated with different methods of internal fixation.


METHODS
Implant removal, corrective osteotomy as needed (3 cases), fixation with a long Gamma nail, and cancellous bone grafting where bone loss (5 cases), all done in a 1-stage procedure.


METHODS
Analysis of clinic and radiologic results. Outcome assessment comparing the preinjury status with the status at a minimum follow-up of 24 months.


RESULTS
At 2 years, 2 patients had died and another patient was lost to follow-up. Thus, 26 patients completed a median follow-up of 27 months (range 24-41 months). Twenty-three of these patients achieved union after 1 procedure (88% effective initial treatment), and 2 patients achieved union after 1 additional procedure each (exchange of a broken nail and bone grafting, respectively), rising the rate of union to 25 of the 26 patients (96%) in a mean of 7 months (range 4-11 months). The other patient remained ununited at the time of her final follow-up. In addition to the broken nail, breakage of the distal bolts occurred in 2 patients with less than 10 mm shortening. Twenty-one of the 26 patients (80.7%) were restored to their preinjury status.


CONCLUSIONS
Subtrochanteric nonunion can be treated effectively using the long Gamma nail for skeletal stabilization, following removal of previously implanted devices.
Barquet
Antonio
A
University Clinic of Traumatology and Orthopaedics, Montevideo, Uruguay.
Mayora
Gabriel
G
Fregeiro
José
J
López
Luis
L
Rienzi
Daniel
D
Francescoli
Luis
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006620:Hip Fractures / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012086:Reoperation / Q000295:instrumentation; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing