• Felix Bonnaire, Thomas Lein, Tim Fülling, and Philipp Bula.
• Städtisches Klinikum Dresden Standort Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany. felix.bonnaire@klinikum-dresden.de.
• Eur J Trauma Emerg Surg. 2020 Oct 1; 46 (5): 955-962.

IntroductionThird-generation nails for the management of unstable trochanteric fractures were evaluated with regard to outcomes.Patients And MethodsA prospective observational study comparing the Gamma 3 nail and the Proximal Femoral Nail Antirotation (PFNA) in 106 unstable trochanteric fractures confirms the recently reported low intra- and postoperative complication rates from retrospective cohort studies.ResultsStudies of same generations of both intramedullary nail systems did not reveal significant differences in intra- or postoperative complications. Intraoperative dislocation during nail insertion occurred 7 times for the Gamma nail and 9 times for the PFNA. The standard PFNA had to be exchanged intraoperatively for a shorter one on two occasions. Superficial wound healing disorders and hematoma requiring revision were observed in four patients in the Gamma 3 nail group and in three patients in the PFNA group. No deep infections were documented. Mechanical complications required revision in four patients (7.5%) after Gamma nailing and in two patients (3.8%) after PFNA. Postoperative rotation of the head-neck fragment was observed for the Gamma nail in three patients, not in the PFNA group. This was not statistically significant (p = 0.08). There were neither incidences of cut out without renewed trauma nor intraoperative fracture or postoperative femoral fracture. Nonunion affected 1 of 18 patients in late follow-up (p = 0.3) in the Gamma 3 nail group.DiscussionThe Gamma 3 nail and the PFNA yielded comparable clinical results and significantly improved outcomes for unstable trochanteric fractures compared to older nail generations.

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