Experience in the use of the long Gamma nail for 16 femoral shaft fracture that have occurred following initial Asian Pacific Gamma nail fixation for pertrochanteric fractures.

From January 1993 to September 2002, 931 patients suffered from intertrochanteric fracture and subrochanteric fracture received open reduction and internal fixation with APGN in our institute. Among these patients, 16 patients (1.7%) developed a femoral shaft fracture after the initial fixation with APGN. Removal of the APGN, closed reduction and fixation with long Gamma nail (LGN) was performed in all the 16 patients. The patients were followed for 12-60 months (average, 39.8 months). The union time of fracture was 12-24 weeks (average, 18.5 weeks) for femoral shaft fractures and 12-20 weeks (average, 16 weeks) for peritrochanteric fractures. Two early complications were noted, including one superficial (6%) infection and one deep (6%) infection. Two malunions (12.5%) developed with no definite functional impairment. The functional results using the Harris hip score were good to excellent. In conclusion, closed reduction and internal fixation with a LGN is very effective in the management of a femoral shaft fracture, a complication of a previous APGN that had been initially used for stabilisation of a pertrochanteric fracture.