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Volume 2025, Issue 1
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

This study aims to present a single-center experience in the management of “intertrochanteric fractures” using Gamma intramedullary (IM) nailing, while also assessing the outcome and complications associated with this approach.

In this prospective study, 72 patients diagnosed with “intertrochanteric fractures” were treated with Gamma IM nails from April 2021 to March 2023. The main outcome was hip function one year following surgery, using the Harris hip score (HHS). The second aim was to identify the factors associated with postoperative complications.

The mean age of the participants was 64.4 ± 4.6 years, and the majority of the patients were female ( = 44, 61.1%). The mean time to union was 15.69 ± 2.72 weeks. At the one-year follow-up, the mean HHS was 84 ± 6.1 points, with a majority of patients ( = 43, 59.7%) achieving a good HHS. An excellent HHS was observed in 11 (15.3%) patients, while a fair score was noted in 15 (20.8%) patients and a poor score was observed in 3 (4.2%) patients. Postoperative mechanical complications were identified in 14 (19.4%) patients, which included failure of osteosynthesis in 4 (5.6%) cases, surgical site infection in 3 (4.2%) cases, nonunion in 3 (4.2%) cases, mal-union in 2 (2.8%) cases, cut-out in one (1.4%) case, and local pain in 1 (1.4%) case. The factors associated with these complications included high-energy trauma ( = 0.028), longer time to surgery (>48 hours) ( < 0.001), the presence of diabetes mellitus ( = 0.001), hypertension ( = 0.037), increased intraoperative blood loss ( = 0.012), and a higher AO classification ( < 0.001).

Our study indicates that Gamma IM nails may effectively manage “intertrochanteric fractures", leading to satisfactory hip function in the majority of patients.

© 2025 Jahaf, Almarrani, Almirah, licensee HBKU Press.
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2025-02-24
2025-04-30
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References

  1. Ong T, Khor HM, Kumar CS, Singh S, Chong E, Ganthel K, et al. The current and future challenges of hip fracture management in Malaysia. Malays Orthop J. 2020Nov; 14:(3):16–21. https://doi.org/10.5704/MOJ.2011.004
     [Google Scholar]
  2. Zhang Z, Qiu Y, Zhang Y, Zhu Y, Sun F, Liu J, et al. Global trends in intertrochanteric hip fracture research from 2001 to 2020: A bibliometric and visualized study. Front Surg. 2021Oct28; 8::756614. https://doi.org/10.3389/fsurg.2021.756614
     [Google Scholar]
  3. Date A, Panthula M, Bolina A. Comparison of clinical and radiological outcomes in intertrochanteric fractures treated with InterTAN nail against conventional cephalomedullary nails: A systematic review. Future Sci OA. 2020Dec7; 7:(1):Fso668. https://doi.org/10.2144/fsoa-2020-0182
     [Google Scholar]
  4. Sah S, Dwidmuthe S, Mohabey A, Roy M. Simultaneous management of acetabular and ipsilateral subtrochanteric femur fractures in a polytrauma patient: A case report. J Emerg Med Trauma Acute Care. 2024Oct15; 2024:(7):1–5. https://doi.org/10.5339/jemtac.2024.27
     [Google Scholar]
  5. Kubiak EN, Bong M, Park SS, Kummer F, Egol K, Koval KJ. Intramedullary fixation of unstable intertrochanteric hip fractures: One or two lag screws. J Orthop Trauma. 2004Jan; 18:(1):12–7. https://doi.org/10.1097/00005131-200401000-00003
     [Google Scholar]
  6. Huang Y, Zhang C, Luo Y. A comparative biomechanical study of proximal femoral nail (InterTAN) and proximal femoral nail antirotation for intertrochanteric fractures. Int Orthop. 2013Dec; 37:(12):2465–73. https://doi.org/10.1007/s00264-013-2120-1
     [Google Scholar]
  7. Nherera L, Trueman P, Horner A, Watson T, Johnstone AJ. Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): A systematic review and meta-analysis for intertrochanteric fractures. J Orthop Surg Res. 2018Mar2; 13:(1):46. https://doi.org/10.1186/s13018-018-0749-6
     [Google Scholar]
  8. Bjørgul K, Reikerås O. Outcome after treatment of complications of Gamma nailing: A prospective study of 554 trochanteric fractures. Acta Orthop. 2007Apr; 78:(2):231–5. https://doi.org/10.1080/17453670710013735
     [Google Scholar]
  9. Hesse B, Gächter A. Complications following the treatment of trochanteric fractures with the gamma nail. Arch Orthop Trauma Surg. 2004Dec; 124:(10):692–8. https://doi.org/10.1007/s00402-004-0744-8
     [Google Scholar]
  10. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995Jul; 77:(7):1058–64. https://doi.org/10.2106/00004623-199507000-00012
     [Google Scholar]
  11. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ, Jr., Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am. 1959Dec; 41-A::1399–408. Available from: https://pubmed.ncbi.nlm.nih.gov/13849408/
     [Google Scholar]
  12. Ramisetty N, Kwon Y, Mohtadi N. Patient-reported outcome measures for hip preservation surgery – a systematic review of the literature. J Hip Preserv Surg. 2015Feb6; 2:(1):15–27. https://doi.org/10.1093/jhps/hnv002
     [Google Scholar]
  13. Areu MMM, von Kaeppler EP, Madison BB, Aguto AA, Alphones J, Zirkle LG, et al. Fixation of intertrochanteric femur fractures using the SIGN intramedullary nail augmented by a lateral plate in a resource-limited setting without intraoperative fluoroscopy: Assessment of functional outcomes at one-year follow-up at Juba Teaching Hospital. OTA Int. 2021Jul16; 4:(3):e133. https://doi.org/10.1097/OI9.0000000000000133
     [Google Scholar]
  14. Audige L, Kellam JF, Lambert S, Madsen JE, Babst R, Andermahr J, et al. The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: Focus on body involvement. J Shoulder Elbow Surg. 2014Feb; 23:(2):189–96. https://doi.org/10.1016/j.jse.2013.07.040
     [Google Scholar]
  15. Hoffmann MF, Khoriaty JD, Sietsema DL, Jones CB. Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures. J Orthop Surg Res. 2019Nov12; 14:(1):360. https://doi.org/10.1186/s13018-019-1431-3
     [Google Scholar]
  16. Jegathesan J, Kwek EBK. Are intertrochanteric fractures evolving? Trends in the elderly population over a 10-year period. Clin Orthop Surg. 2022Mar; 14:(1):13–20. https://doi.org/10.4055/cios20204
     [Google Scholar]
  17. Trincado RM, Mori MAK, Fernandes LS, Perlaky TA, Hungria JOS. Epidemiology of proximal femur fracture in older adults in a philanthropical hospital in São Paulo. Acta Ortop Bras. 2022Dec16; 30:(6):e255963. https://doi.org/10.1590/1413-785220223006e255963
     [Google Scholar]
  18. Rahman MAK,, Siddiqui YS, Julfiqar M, Khan AQ, Sabir AB, Abbas M. Short versus long proximal femoral nail in the management of intertrochanteric fractures – a comparative study. Int J Burns Trauma. 2023Jun15; 13:(3):99–109. Available from: https://pubmed.ncbi.nlm.nih.gov/37455801/
     [Google Scholar]
  19. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2008Jul 16:(3):CD000093. https://doi.org/10.1002/14651858.CD000093
     [Google Scholar]
  20. Lewis SR, Macey R, Gill JR, Parker MJ, Griffin XL. Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults. Cochrane Database Syst Rev. 2022Jan 26; 1:(1):CD000093. https://doi.org/10.1002/14651858.CD000093
     [Google Scholar]
  21. Yu X, Wang H, Duan X, Liu M, Xiang Z. Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis. Acta Orthop Traumatol Turc. 2018Jul; 52:(4):299–307. https://doi.org/10.1016/j.aott.2018.02.009
     [Google Scholar]
  22. Kempf I, Grosse A, Taglang G, Favreul E. Gamma nail in the treatment of closed trochanteric fractures. Results and indications of 121 cases. Orthop Traumatol Surg Res. 2014Feb; 100:(1):75–83. https://doi.org/10.1016/j.otsr.2013.12.013
     [Google Scholar]
  23. Yalin M, Golgelioglu F, Key S. Intertrochanteric femoral fractures: A comparison of clinical and radiographic results with the proximal femoral intramedullary nail (PROFIN), the anti-rotation proximal femoral nail (A-PFN), and the InterTAN Nail. Medicina (Kaunas). 2023Mar13; 59:(3):559. https://doi.org/10.3390/medicina59030559
     [Google Scholar]
  24. Harshwardhan H, Jain S, Sharma M. An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II. Int J Res Orthop. 2019Jul–Aug; 5:(4):699–702. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20192687
     [Google Scholar]
  25. Fogagnolo F, Kfuri M, Jr., Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004Jan; 124:(1):31–7. https://doi.org/10.1007/s00402-003-0586-9
     [Google Scholar]
  26. Ju JB, Zhang PX, Jiang BG. Hip replacement as alternative to intramedullary nail in elderly patients with unstable intertrochanteric fracture: A systematic review and meta-analysis. Orthop Surg. 2019Oct; 11:(5):745–54. https://doi.org/10.1111/os.12532
     [Google Scholar]
  27. Horwitz DS, Tawari A, Suk M. Nail length in the management of intertrochanteric fracture of the femur. J Am Acad Orthop Surg. 2016Jun; 24:(6):e50–8. https://doi.org/10.5435/JAAOS-D-15-00325
     [Google Scholar]
  28. Zarie M, Mohamoud MF, Farhoud AR, Bagheri N, Khan FMY, Heshmatifar M, et al. Evaluation of the inter and intra-observer reliability of the AO classification of intertrochanteric fractures and the device choice (DHS, PFNA, and DCS) of fixations. Ethiop J Health Sci. 2020Sep; 30:(5):755–60. https://doi.org/10.4314/ejhs.v30i5.15
     [Google Scholar]
  29. Utrilla AL, Reig JS, Muñoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: A randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma. 2005Apr; 19:(4):229–33. https://doi.org/10.1097/01.bot.0000151819.95075.ad
     [Google Scholar]
  30. Queally JM, Harris E, Handoll HH, Parker MJ. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2014Sep 12; 2014:(9):CD004961. https://doi.org/10.1002/14651858.CD004961
     [Google Scholar]
  31. Schemitsch EH, Nowak LL, Schulz AP, Brink O, Poolman RW, Mehta S, et al. Intramedullary nailing vs sliding hip screw in trochanteric fracture management: The INSITE randomized clinical trial. JAMA Netw Open. 2023Jun1; 6:(6):e2317164. https://doi.org/10.1001/jamanetworkopen.2023.17164
     [Google Scholar]
  32. Sivakumar A, Edwards S, Millar S, Thewlis D, Rickman M. Reoperation rates after proximal femur fracture fixation with single and dual screw femoral nails: A systematic review and meta-analysis. EFORT Open Rev. 2022Jul5; 7:(7):506–15. https://doi.org/10.1530/EOR-21-0067
     [Google Scholar]
  33. Norris R, Bhattacharjee D, Parker MJ. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: A systematic review of 13,568 patients. Injury. 2012Jun; 43:(6):706–11. https://doi.org/10.1016/j.injury.2011.10.027
     [Google Scholar]
  34. Vicenti G, Carrozzo M, Caiaffa V, Abate A, Solarino G, Bizzoca D, et al. The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: A radiological study. Int Orthop. 2019Jan; 43:(1):193–200. https://doi.org/10.1007/s00264-018-4214-2
     [Google Scholar]
  35. Manon J, Detrembleur C, Van de Veyver S, Tribak K, Cornu O, Putineanu D. Predictors of mechanical complications after intramedullary nailing of tibial fractures. Orthop Traumatol Surg Res. 2019May; 105:(3):523–7. https://doi.org/10.1016/j.otsr.2019.01.015
     [Google Scholar]
  36. Amer KM, Congiusta DV, Jain K, Dalcortivo RL, Benevenia J, Vosbikian MM, et al. Complication rates in intertrochanteric fractures: A database analysis comparing sliding hip screw and cephalomedullary nail. Arch Bone Jt Surg. 2024; 12:(7):506–14. https://doi.org/10.22038/ABJS.2024.64188.3081
     [Google Scholar]
  37. Vakharia AM, Haase LR, Speybroeck J, Furdock R, Ina J, Ochenjele G. Utilization trends, patient-demographics, and comparison of medical complications of sliding hip screw or intramedullary nail for intertrochanteric fractures: A nationwide analysis from 2005 to 2014 of the medicare population. Iowa Orthop J. 2023Dec; 43:(2):163–71. Available from https://pmc.ncbi.nlm.nih.gov/articles/PMC10777688/
     [Google Scholar]
/content/journals/10.5339/jemtac.2025.7
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Outcome of intertrochanteric femur fractures treated with Gamma intramedullary nails: A prospective study from a resource-limited setting
Journal of Emergency Medicine, Trauma and Acute Care 2025, 7 (2025); https://doi.org/10.5339/jemtac.2025.7
/content/journals/10.5339/jemtac.2025.7
/content/journals/10.5339/jemtac.2025.7
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  • Article Type: Research Article
Keyword(s): complications, functional outcome, Gamma nail, Harris hip score, intertrochanteric fracture and intramedullary nailing

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