Comparison of compression hip screw and gamma nail for treatment of peritrochanteric fractures.

Twenty-seven peritrochanteric fractures in 27 patients were evaluated and treated prospectively. Ten fractures were internally fixed with compression hip screws (CHS) (Omega Howmedica, Rutherford, NJ) and 135 degrees, four-hole side plates. Internal fixation of the posteromedial fragment was not done. Eleven fractures were internally fixed with Gamma nails with distal screws. Six fractures were internally fixed with Gamma nails without distal screws. Each group was evaluated for surgical time, blood loss, hospital days, collapse of the fracture, infections, cut out of the lag screw from the femoral head, fracture healing, perioperative femoral shaft fractures, and implant failure. Surgery time did not differ significantly in either group. Blood loss and hospital days were less in the Gamma nail group. There were no infections, cut out of the lag screw, implant fractures, or pulmonary complications in either group. Fracture healing was the same in both groups. Those fractures treated with Gamma nails, both with and without distal screws, had 50% less collapse than those treated with CHS. There were two femoral shaft fractures in the Gamma nail group (11.76%). There were no femoral shaft fractures in the CHS group. Fractures of the femoral shaft were believed to be caused by two factors: a mismatch of the nail design and the normal geometry of the proximal femur and stress risers in the femoral shaft caused by repeatedly missing the screw hole with the drill bit. Although the Gamma nail is an excellent device for stabilizing and preventing collapse of unstable peritrochanteric fractures, the learning curve is high, and femoral shaft fractures can occur. We believe precautions outlined in this report are helpful in preventing these complications.