title: Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail.
abstract: OBJECTIVE
  To compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures.
  
  
  METHODS
  Prospective randomized.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Two hundred ten consecutive patients older than 65 years with trochanteric femoral fractures.
  
  
  METHODS
  Treatment with a compression hip screw or a new design of the Trochanteric Gamma nail (180 mm in length with a mediolateral angle of 4 degrees and available only with a proximal diameter of 17 mm and distal diameter of 11 mm).
  
  
  METHODS
  Operative and fluoroscopy times, blood loss, functional outcome, complication rate, and failure of fixation.
  
  
  RESULTS
  The Trochanteric Gamma nail was used in 104 patients and the compression hip screw in 106. The 2 groups were similar in terms of their preoperative data, with a median follow-up of 13.6 months (range 12-30). The results show no difference in operating time (P = 0.21), but the Trochanteric Gamma nail group had a significantly shorter fluoroscopy time (P = 0.006), and the number of patients transfused and the mean of units of blood transfused were significantly less in the Trochanteric Gamma nail group (P = 0.013, 0.046, respectively). Mortality within 12 months was similar in both groups (P = 0.83). All fractures were radiographically healed at the last visit. There was no difference in intraoperative and postoperative complications or rate of fixation failure between the 2 groups, and no case of secondary shaft fracture of the femur was encountered in this study. In the entire series, there was no difference in the functional outcome (P = 0.74), but the postoperative walking ability was better in those patients with unstable fractures who were treated with the Trochanteric Gamma nail (P = 0.017).
  
  
  CONCLUSIONS
  The new Trochanteric Gamma nail is an effective method for the treatment of trochanteric femoral fractures in elderly patients. The indication for either Trochanteric Gamma nail or compression hip screw is similar in stable fractures, but we recommend the use of the Trochanteric Gamma nail for unstable trochanteric fractures.
authors.affiliation: Department of Orthopaedic Surgery, Hospital General Elda, Elda, Alicante, Spain. lizaur@telefonica.net
authors.forename: A Lizaur
authors.initials: AL
authors.lastname: Utrilla
authors.forename: J Sanz
authors.initials: JS
authors.lastname: Reig
authors.forename: F Miralles
authors.initials: FM
authors.lastname: Muñoz
authors.forename: C Bendala
authors.initials: CB
authors.lastname: Tufanisco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D004867:Equipment Design; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies