THE TITANIUM 3 GAMMA NAIL: REDUCING COMPLICATIONS BY EVOLUTIONARY DESIGNS – 3 COMPARATIVE STUDIES

Abstract

Introduction: The Gamma nail is an often used implant in trochanteric femur fractures. With the intramedullar application it is especially suitable for osteosynthesis of unstable fractures with a lack of medial buttress. Since first using this implant in the late 80s, the design has been changed twice. 1992 we started to use the Gammanail, since then 835 nails have been inserted by 165 different surgeons. The design changed 1996 and 2004. The aim of this study is to compare the results of the three different designs and to prove the good results of the latest Gamma3-nail.

Materials and Methods: The first series was done from 1992 to 1996 (157 Patients), the second from 1996 to 2001(234 Patients) and the third from 2004 up to now(208 Patients).

We analysed operation- and follow-up reports, as well as available radiographs with a main interest in implant-related complications. The complications were analysed by dividing them into intraoperative and late complications. The three groups were similar in relation to the epidemiology in a trauma1-center. The average age was 79,8 years (49 to 101y), 40 different surgeons in each group, the mean operation time 49 min. (15 to 139 min.) and the fracture types were (according to the AO-classification): A1 28%, A2 56%, A3 11% and B2 3%. Those treated with a long nail or with a pathological fracture were excluded.

Results: The intraoperative complications (open reduction, splitting of the major trochanter, distal locking, fractures of the shaft) were 34% in the first series, 10.5% in the second series and 5.3% in the third series. The postoperative and late complications related to the implant (sintering of the fracture, cut out, pseudarthrosis, infection and malunion) was 24% in the first group, 10% in the second group and only 3.3% in the third group of the new design. Therefore the reoperation rate was the same, as all patients of this complication-group in all series were re-operated. General complications were exitus letalis 8.5%, pneumonia 5.2%, illeus 2%, CVI 3.9%, TVT 2%, ACS 1.3% - the same in each series.

Conclusion: In comparison to the data of our earlier studies on this gamma nail, patients treated with the new design and the new instruments had fewer complications and have a lower re-operation-rate than reported in the literature. This evolution of the design and the instruments of this sort of nail lead to a very low complication-rate according to the age-group and number of surgeons that were involved. The low complication-rate allows the broad usage of this nail, despite the fact that it is more expensive than other comparable implants.