Mechanical failure of the long gamma nail was encountered in two elderly patients with proximal femur fractures over a 6-month period. One of the patients had a known history of lymphoma. The other patient had a history of rheumatoid arthritis but no history of cancer or other metabolic bone disease. Both nails failed at the junction of the compression screw and the nail. The angle of failure of the nail was the same in both cases. The index of suspicion for imminent mechanical failure of the gamma nail should be higher in pathologic fractures and fractures which are malreduced during nailing.
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