Implant breakage, a rare complication with the Gamma nail. A review of 843 fractures of the proximal femur treated with a Gamma nail.

Internal fixation with a Gamma nail, in its short and long versions, is an excellent surgical technique for intertrochanteric and subtrochanteric fractures of the femur. A stable osteosynthesis is obtained which allows early mobilisation and promotes healing of the fracture. However, it is not free from complications; many of them are due to poor surgical technique and/or inadequate monitoring. Breakage due to fatigue of the material is an exceptional complication. A review of 843 cases operated in our department between 1990 and 2002 was made. Five cases of implant breakage were found. Non-union of the fracture appears to be the primary cause. The weakest point of the Gamma nail is the opening for the cervical screw. The optimal treatment will depend on each particular case. The possibility of dynamisation of the construct should be considered when delayed healing is suspected.