The gamma interlocking nail, designed combining the advantages of the sliding hip screw with the intramedullary nail, was initially introduced for the management of unstable proximal femoral fractures. However the unacceptably high incidence of lateral femoral shaft fractures led to the development of the long gamma nail. This is the result of a prospective study of the use of the long gamma nail in 35 patients over a 7 year period till March 2000. The mean age of the patients was 69.9 years. There were 13 men and 22 women. All but two of the fractures had a subtrochanteric component. Ten were pathological fractures. An identical size of nail was used in all cases. Elderly patients were permitted to mobilise without restriction, whereas partial weight bearing was imposed on the younger patients till some signs of radiological healing. Patients were reviewed at a hip fracture clinic. Mean clinical follow up was 381 days and radiological follow up was 244 days. Mean hospital stay 22 days. The post operative mortality at 30 days was 20%, rising to 45% at one year. General complications that occurred were pneumonia – 3, fat embolism – 1, myocardial infarction – 1, and GI bleed – 1. Four cases had superficial wound infection, which resolved with oral antibiotics. Fracture related complications occurred in 4 cases. These were intra-operative femoral shaft fracture – 1, fracture at tip of nail – 1, nail breakage – 2. All went on to heal after exchange nailing. The long gamma nail does not appear to have reduce the post-operative incidence of femoral fractures, which is most likely related to the large size of the distal locking screws and stress concentration at the tip of the nail. The two cases of nail breakage appear to reflect metal fatigue failure in the setting of delayed union in younger patients.
This is a retrospective comparative review of the clinical results of arthroscopic meniscal repairs between the use of meniscal arrows and sutures. The study group consists of 37 repairs in 35 patients carried out by 2 special knee surgeons over a five-year period. The arrow group consisted of 23 repairs in 21 patients. There were 14 males and 7 females. The medial meniscus was repaired in 13 and the lateral in 10 cases. Associated anterior cruciate ligament injured was present in 11 patients, of whom 9 underwent concomitant reconstruction along with the meniscal repair. The suture group comprised 14 cases. Ten were male and 4 female. There were 8 medial meniscal repairs and 6 lateral. The anterior cruciate was also torn in 8 cases, of whom 6 had it reconstructed. The repairs were carried out use #0-PDS by an out-to-in technique. The 2 groups were grossly age and sex matched. Tears were located in zone 0/1, mainly in the posterior third segment of the meniscus. The rehabilitation protocol was similar in both groups. Minimum follow up was 9 months. Patients were evaluated by clinical review; questionnaire based on the Lysholm score and case record analysis. The overall clinical success rate for the arrows group was 13/23 (56.5%) compared to 11/14 (78.6%) for the suture group. Complications noted were broken arrows – 4 cases, cutaneous nerve entrapment by suture – 1, and delayed portal healing due to suture irritation – 1. In conclusion, arthroscopic suture repair provided better clinical healing rates than meniscal arrows. Arrow breakage is a significant factor contributing to non-healing of initial tear repairs.