Analysis of Complications and Results of Revision Surgeries after 1496 Gamma Nailings - A Multicenter Study

Abstract

74 out of 1 496 patients (4.94 %) with intertrochanteric fractures operated with the Howmedica® Gamma nail underwent revision surgery due to complications. A retrospective analysis of these 74 cases is presented. Primary surgery was performed within 48 hours in 83 % of the cases. First choice of implant was the standard gamma nail. The nail was implanted after intramedullary reaming in 66 % and primary surgery was assessed as good to excellent in 66 %. Full weight bearing was achieved within 1 week in 40 % of patients. The head screw was in a cranial position in 30 %, the distance between the screw tip and the cortex of the femoral head was on average 6.16 mm (range: 1-20 mm). This was measured on antero-posterior radiographs. In 15 % (11 cases) cut-out was detected after 15.7 weeks (range: 2-55 weeks) postoperatively. Diaphyseal fractures at the nail tip were found in 12 %, rotational dislocation (more than 20°) in 8 %. Superficial wound infection was reported in 5.4 % (0.26 % of the total 1 496 cases) while deep infection occurred in 16.2 % (0.8 % of 1 496). Frequent methods of revision surgeries included change of nail (34 %) and prosthesis (11 %). After revision surgeries lethal complications were found in 11 %, after an average period of 3 months (range: 0.5-6 months).

Key words

intertrochanteric fractures - head screw - revision surgery - cut-out - infection

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