Failure of the gamma nail in a highly unstable proximal femur fracture: report of four cases encountered in The Netherlands.

Static forces of body weight and dynamic forces induced by walking are a challenge toward lasting fixation devices in the case of unstable peritrochanteric fractures. Experiences with the newly developed gamma nail internal fixation technique are promising. The fixation is stable, complication rates are low, and fractures of the gamma nail itself have not been reported before. From the Dutch experience, the authors describe the four known cases of implant failure. In cases in which the process of bony healing is disturbed, the dynamic stresses during ambulation become large enough to cause metal fatigue fractures. In these cases adjuvant and appropriate measures should be undertaken.