Background:The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented. Methods: A prospective randomized study was used to compare the Ambi hip screw and the Gamma nail for the treatment of 69 patients over the age of 50 years with intertrochanteric femoral fractures. The groups were similar with respect to age, sex, prefracture mobility and abode, anaesthetic risk grade, CT measured bone density and fracture pattern.Results: Those treated with the Gamma nail had a significantly longer image intensifier screening time ( P < 0.05), greater blood loss ( P < 0.01) and more operative complications. There was no difference in the length of hospital stay but the level of mobility recovered was significantly better in the Ambi group at 6 months follow up. Urine retention was the most frequent complication but did not correlate with the implant or method of anaesthesia. Two implants cut out, one in each group. Limb shortening was similar in both groups and was not affected by leaving the Gamma nail unlocked distally in unstable fractures. Thirteen patients died from pre-existing medical conditions. Conclusions: The Gamma nail proved technically more demanding with higher intra-operative complications and inferior return of mobility.

The survivorship method of analysis has been used to evaluate retrospectively the outcome of 1166 total hip arthroplasties performed in Taranaki between 1970 and 1989. There were 867 cemented Charnley, 105 Harris Galante and 92 cemented Muller prostheses. Outcome was determined in 99.1% of the cases. There were 72 failures in the Chamley group, resulting in an annual failure rate of 1.78% and a 15 year survival rate of 73%. There were 26 failures in the Muller group, an annual failure of 6.93% and an 11 year survival of 63%. At review none of the Harris Galante group had failed. Survival was affected by age, sex, hospital and surgeon.