Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw

TLDR

We prospectively compared fixation of 100 intertrochanteric fractures in elderly patients using either a Dynamic Hip Screw or the Gamma nail, randomly assigning patients to each device. The study found no difference in operative time, blood loss, complications, hospital stay, discharge location, mobility, or fixation failure between the DHS and Gamma nail, but the Gamma nail group had four femoral fractures near the nail requiring additional surgery, while union was achieved by six months in both groups.

Abstract

We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients' mobility at final review. There was no difference in failure of proximal fixation: cut-out occurred in three cases with the DHS, and twice with the Gamma nail. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery. In the absence of these complications, union was seen by six months in both groups.