Intramedullary osteosynthesis with gamma nail in treatment of peritrochanteric fractures of the femur.

INTRODUCTION

The treatment of peritrochanteric fractures of the femur, particularly in elderly people is a therapeutic challenge for the surgeon, not only due to the patient's age but also the type of fracture. The aim of the present paper is to assess the efficacy of closed intramedullary osteosynthesis with a gamma nail in the treatment of peritrochanteric fractures depending on the type of fracture and patient age.

MATERIAL AND METHODS

The study involved 109 patients treated at the Orthopaedic and Trauma Department of A. Sokolowski Hospital in Walbrzych in 2006. The mean age of the patients was 72 years (range 15-95). The follow-up period was 6-20 months, 15 months on average. A detailed assessment involved 97 patients aged 50 years and older. The study utilised AO and Kyle's classifications of fractures; the criteria of Golec and the 27th Congress of the Polish Society of Orthopaedics and Traumatology (PSOT) were used for radiographic assessment; and the Harris scale was used for functional assessment.

RESULTS

According to the standards of radiographic assessment, 75% of patients had excellent and good results, indicating good mechanical efficacy of intramedullary fixation and good fracture consolidation. According to the Harris scale, 13% of the patients achieved poor scores in the functional assessment. The poor results were related to the age of the patients and co-existing general diseases rather than to the degree of fracture instability.

CONCLUSIONS

In stable peritrochanteric fractures of the femur, intramedullary gamma nailing was associated with good and excellent results irrespective of the patient's age. Poorer functional results in patients aged 71 or older were due to poorer pre-injury general health and local status of the patient.