• A Lizaur Utrilla, J Sanz Reig, F Miralles Muñoz, and C Bendala Tufanisco.
• Department of Orthopaedic Surgery, Hospital General Elda, Elda, Alicante, Spain. lizaur@telefonica.net
• J Orthop Trauma. 2005 Apr 1;19(4):229-33.

ObjectivesTo compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures.DesignProspective randomized.SettingLevel 1 trauma center.PatientsTwo hundred ten consecutive patients older than 65 years with trochanteric femoral fractures.InterventionsTreatment with a compression hip screw or a new design of the Trochanteric Gamma nail (180 mm in length with a mediolateral angle of 4 degrees and available only with a proximal diameter of 17 mm and distal diameter of 11 mm).Main Outcome MeasurementsOperative and fluoroscopy times, blood loss, functional outcome, complication rate, and failure of fixation.ResultsThe Trochanteric Gamma nail was used in 104 patients and the compression hip screw in 106. The 2 groups were similar in terms of their preoperative data, with a median follow-up of 13.6 months (range 12-30). The results show no difference in operating time (P = 0.21), but the Trochanteric Gamma nail group had a significantly shorter fluoroscopy time (P = 0.006), and the number of patients transfused and the mean of units of blood transfused were significantly less in the Trochanteric Gamma nail group (P = 0.013, 0.046, respectively). Mortality within 12 months was similar in both groups (P = 0.83). All fractures were radiographically healed at the last visit. There was no difference in intraoperative and postoperative complications or rate of fixation failure between the 2 groups, and no case of secondary shaft fracture of the femur was encountered in this study. In the entire series, there was no difference in the functional outcome (P = 0.74), but the postoperative walking ability was better in those patients with unstable fractures who were treated with the Trochanteric Gamma nail (P = 0.017).ConclusionsThe new Trochanteric Gamma nail is an effective method for the treatment of trochanteric femoral fractures in elderly patients. The indication for either Trochanteric Gamma nail or compression hip screw is similar in stable fractures, but we recommend the use of the Trochanteric Gamma nail for unstable trochanteric fractures.

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