Introduction and purpose: The Gamma nail (Howmedica, Kiel) was designed in the eighties as an alternative to sliding plate-screw systems for the treatment of per and subtrochanteric lesions of the proximal femur. The purpose of this study is to analyze eight instances where a breakage of the gamma nail occurred trying to establish possible causes and therapeutic alternatives.

Materials and methods: This is a retrospective study on 1478 Gamma nails implanted in our hospital between 1989 and 2002 (standard: 1287, long: 174; trohchanteric: 17). 11 cases of material breakage were detected, of which three corresponded to the breakage of the distal screws and eight to breakages of the nail itself. The clinical records and imaging tests of these patients were carefully scrutinized.

Results: The standard Gamma nail failure rate was .15% (2 breakages) and that of the long Gamma nail was 3.4% (2 breakages). The breakages occurred a mean of 15.6 months after the initial procedure. In 5 cases the nail broke at a site of fracture malunion and in the other three they broke in fully healed or nearly healed fractures.

Conclusions: Gamma nail breakage is an unusual complication. Our failure rate was similar to those published by other authors. In most cases nail breakage was related to malunited fracture. In these cases we withdrew the implant and implanted a new intramedullary device which led to healing.