Prevention of fracture at the distal locking site of the gamma nail. A biomechanical study

Abstract

To investigate the origin of fractures at the distal locking site of the Gamma nail, we loaded ten paired human cadaver femora fixed with a Gamma nail in torsion until they fractured. When an awl was hammered in to start the hole for distal locking a fissure appeared in the lateral cortex of all the femora, and the mean torsional load to create a fracture was reduced by 57.8% compared with that in a control group in which the distal locking hole had been started with a centre drill. When an additional drill hole was made, the mean failure load in torsion decreased by 35.7%. We strongly recommend that an awl should not be used at the distal locking site of the Gamma nail; we recommend the use of a centre drill. Additional drill holes should be avoided because they act as stress raisers.

More postoperative femoral fractures with the Gamma nail than the sliding screw plate in the treatment of trochanteric fractures

“…According to Haynes et al (1997), the Gamma nail has a higher failure load than the Dynamic Hip Screw (DHS). It has been suggested that postoperative femoral fractures occur due to the drilling of holes for distal locking screws, too forceful insertion of the nail into the femoral shaft, the use of too large a nail, or insufcient or excessive reaming of the femoral canal before insertion of the nail (Lacroix et al 1995, Boriani et al 1996. However, in our study, only 2 of the 17 postoperative femoral shaft fractures after xation with Gamma nail were related to locking screws.…”

Intra- und perioperative Komplikationen bei der Stabilisierung von per- und subtrochantären Femurfrakturen mittels PFN ®

“…In den vergangenen Jahren sind zahlreiche Publikationen über die Versorgung instabiler per-oder subtrochantärer Femurfrakturen [3,6,11,14,17,22,23] mittels intramedullärer Kraftträger erschienen. Erste Erfahrungen mit dem PFN ® sind nun ebenfalls publiziert [4,18].…”

Distal locking in short hip nails: Cause or prevention of peri-implant fractures?

“…However, it has been accompanied by serious peri-implant femur fracture complications. Reports emerged identifying distal locking, and the problems associated with it, as a cause of postoperative femoral fractures [1,[5][6][7][8].…”