title: How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System.
abstract: OBJECTIVE
  The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails.
  
  
  METHODS
  The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail.
  
  
  RESULTS
  The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group.
  
  
  CONCLUSIONS
  The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.
authors.affiliation: Ospedali Riuniti , Ancona, Italy. raffaele.pascarella@libero.it.
authors.forename: R
authors.initials: R
authors.lastname: Pascarella
authors.affiliation: Ospedali Riuniti , Ancona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fantasia
authors.affiliation: Ospedali Riuniti , Ancona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Maresca
authors.affiliation: Ospedali Riuniti , Ancona, Italy.|Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bettuzzi
authors.affiliation: Ospedali Riuniti , Ancona, Italy.|Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Amendola
authors.affiliation: Ospedali Riuniti , Ancona, Italy.|Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Violini
authors.affiliation: Ospedali Riuniti , Ancona, Italy.|Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cuoghi
authors.affiliation: Ospedali Riuniti , Ancona, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Sangiovanni
authors.affiliation: Ospedali Riuniti , Ancona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cerbasi
authors.affiliation: Ospedali Riuniti , Ancona, Italy.|Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Boriani
authors.affiliation: Ospedali Riuniti , Ancona, Italy.|Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
authors.forename: D S
authors.initials: DS
authors.lastname: Tigani
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D012189:Retrospective Studies
keywords: Cutout; Gamma Nail System; Nail; Pertrochanteric fractures; Trochanteric