First Quarter 2005

Innovative Fixation Device Improves Hip Fracture Repair

Thomas R. Thompson, MD
Senior Staff,
Department of Orthopaedic Surgery, AGMC

Hip fracture operations are the most common inpatient surgical procedures performed by orthopaedic surgeons. More than 300,000 hip fractures occur in this country every year with the prediction of a steady increase as life spans are increased. This mandates a continuing need for innovation in hip fracture fixation in order to maximize efficiency, quality, and economy in caring for this group of patients.

The Gamma Nail is one such innovative hip fracture fixation device. It is indicated for the fixation of hip fractures in the intertrochanteric and subtrochanteric regions. The device has been used at Akron General Medical Center since 1991 and it is especially helpful in the fixation of comminuted, unstable patterns.

The current Gamma Nail model (Gamma 3) is a third-generation implant with streamlined instrumentation and a smaller, stronger titanium body. It comes in two sizes. The standard Gamma 3 is the shorter version used for regular intertrochanteric fractures. The long Gamma 3 is used for complex intertrochanteric and subtrochanteric hip fractures, allowing fixation down to the knee. It is inserted percutaneously through three 1cm incisions using intraoperative x-ray guidance. It does not strip periosteum from fracture fragments.

The Gamma Nail offers superior biomechanical fixation when compared with plates. Fracture stability is achieved by secure attachment into the femoral head and intramedullary canal: significant comminution within the trochanters does not affect its insertion or fixation properties. Wound healing is easier on the patient due to the small insertion sites, although blood loss is similar to that of plate fixation due to the need for intramedullary reaming.

Suggested reading list:
1. Lorich DG, Geller DS, Nielson JH. Osteoporotic peritrochanteric hip fractures. Instr Course Lect. 2004; 86: 398-410. .
2. Rosenblum SF, et al. A biomechanical evaluation of the Gamma nail. J Bone Joint Surgery Br.1992; 74:352-357.