The prevention of complications with the Gamma Locking Nail.

The general acceptance of the Gamma Locking Nail (Howmedica, Rutherford, New Jersey) in the United States has been slow, because of reported intraoperative fractures of the shaft of the femur occurring with use of this nail. A series of 63 consecutive intertrochanteric and subtrochanteric fractures of the femur is reported. There were no intraoperative or postoperative fractures of the shaft of the femur in this series. Intraoperative fractures are avoided by appropriate over-reaming of the shaft of the femur, insertion of the device by hand only, and drilling no more than one hole for each distal locking screw. The use of a hammer during insertion of the Gamma Nail will be associated with femoral shaft fractures. Proper positioning of the lag screw in the head and neck of the femur will prevent migration of the lag screw in the head of the femur. The Gamma Nail has a definite place in the treatment of fractures of the proximal femur.