Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases.

Objectives: The aim of this study was to compare the complications of the trochanteric gamma nail (TGN) and the Gamma3 Nail (G3), focusing on cutout failure.

Design: Retrospective comparative cohort analysis.

Setting: Level II Teaching Trauma Center academic trauma center.

Patients/methods: Two hundred eighteen trochanteric fractures with a mean follow-up of 15 months were included in the study. They were treated either with the TGN or the G3 between January 2005 and December 2010. Bivariate, stratified, and logistic regression analysis was conducted to determine the association between cutout and the independent variables.

Intervention: Proximal anterograde nailing with either the TGN or the G3.

Main Outcome Measurements: Patient age, sex, type of intramedullary device, stability fracture pattern, tip-apex distance (TAD), distraction at the fracture site, cervical angle, and cutout.

Results: The relative risk (RR) of cutout was 4.71 times higher in the group treated with G3 (P < 0.01). RR of cutout for unstable fractures compared with stable fractures was 3.07 (1.01-9.35). In unstable fractures, the RR of cutout was 8.78 times higher in patients with G3 (P < 0.01). RR of cutout was 1.54 times higher with TAD >25 mm (P = 0.4).

Discussion: We have not found any relationship between cutout rate and TAD. Only the fracture pattern and the type of implant have shown to be associated with cutout risk. In our study, Gamma3 Nail has higher cutout rates than TGN in unstable fractures.

Level Of Evidence: Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.