title: Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases.
abstract: OBJECTIVE
  The aim of this study was to compare the complications of the trochanteric gamma nail (TGN) and the Gamma3 Nail (G3), focusing on cutout failure.
  
  
  METHODS
  Retrospective comparative cohort analysis.
  
  
  METHODS
  Level II Teaching Trauma Center academic trauma center.
  
  
  METHODS
  Two hundred eighteen trochanteric fractures with a mean follow-up of 15 months were included in the study. They were treated either with the TGN or the G3 between January 2005 and December 2010. Bivariate, stratified, and logistic regression analysis was conducted to determine the association between cutout and the independent variables.
  
  
  METHODS
  Proximal anterograde nailing with either the TGN or the G3.
  
  
  METHODS
  Patient age, sex, type of intramedullary device, stability fracture pattern, tip-apex distance (TAD), distraction at the fracture site, cervical angle, and cutout.
  
  
  RESULTS
  The relative risk (RR) of cutout was 4.71 times higher in the group treated with G3 (P < 0.01). RR of cutout for unstable fractures compared with stable fractures was 3.07 (1.01-9.35). In unstable fractures, the RR of cutout was 8.78 times higher in patients with G3 (P < 0.01). RR of cutout was 1.54 times higher with TAD >25 mm (P = 0.4).
  
  
  CONCLUSIONS
  We have not found any relationship between cutout rate and TAD. Only the fracture pattern and the type of implant have shown to be associated with cutout risk. In our study, Gamma3 Nail has higher cutout rates than TGN in unstable fractures.
  
  
  METHODS
  Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics and Traumatology, Complejo Hospitalario de Palencia, Palencia, Spain; †Department of Epidemiology, Hospital Clinico San Carlos, Madrid, Spain; ‡Department of Orthopaedics and Trauma, Complejo Hospitalario de Segovia, Segovia, Spain; and §Department of Orthopaedics and Traumatology, Hospital Rio Hortega, Valladolid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Mingo-Robinet
authors.forename: Miguel
authors.initials: M
authors.lastname: Torres-Torres
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez-Cervell
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Alonso Del Olmo
authors.forename: Jose A
authors.initials: JA
authors.lastname: Rivas Laso
authors.forename: Hector
authors.initials: H
authors.lastname: Aguado-Hernández
authors.forename: Isidro
authors.initials: I
authors.lastname: Burón-Alvarez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000009:adverse effects*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000295:instrumentation; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012306:Risk