[Gamma nail in the treatment of closed trochanteric fractures. Results and indications apropos of 121 cases].

The Gamma Nail, developed at the Centre for traumatology and orthopaedics of Strasbourg, is the latest advance in the treatment of trochanteric fractures, based on the intra-medullary principle and on the closed procedure. It was inspired both by the Y nail of Küntscher and by the interloking nail. This is the study of the results of a first series of 121 cases treated between 1988 and 1990 and followed until consolidation. The mean age was 75 years, mostly patients in poor general condition, unstable fracture types were predominant. The preoperative reduction was anatomic in 72 per cent and the quality of osteosynthesis was good in 66 per cent, acceptable in 27 per cent; 83.4 per cent of the patients resumed full weight bearing during the first week. Only one case of deep infection occurred, treated by Gentamicyn beeds without removal of the nail. The mortality rate was 12.3 per cent at three months. We note 7 malunions in varus > 10 degrees, 3 in valgus > 10 degrees, 2 in external rotation > 10 degrees and 1 internal rotation > 10 degrees. In six cases, there was a cut out of the femoral head by the screw (in two cases the screws were too short, in four cases they were in a bad position). The same criticism against all surgical methods of treatment of trochanteric fractures can be done against the Gamma Nail. Nevertheless, it keeps the advantages of a closed procedure and, in comparison to the Ender nail, the absence of knee pain and the systematic weight bearing whatever the fracture type.