Breakage of a Third Generation Gamma Nail: A Case Report and Review of the Literature

Abstract

The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant.

Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

“…Nonetheless, this figure is consistent with the 0.2-5.6% rate observed in the literature. 4,5,6 This figure is also comparable with the 1.3%…”

“…Reported rates of cephalomedullary nail fracture range from to 0.2% to 5.6%. [4][5][6] Given the gravity of the event, it is important to determine patient factors which contribute to and are associated with this form of implant failure. No previous studies have determined patient-specific factors that predisposed to nail fracture.…”

Fracturas de cadera de trazo basicervical con inestabilidad rotacional: estudio retrospectivo de la eficacia de dos sistemas de incremento de la estabilidad mecánica del implante

“…Se estima una incidencia de rotura del implante entre el 0.2-5.7% (173,174,177,178,182,(196)(197)(198) en la primera generación, no estando documentados datos fiables para la segunda y tercera salvo casos aislados (199). La rotura acontece habitualmente en el orificio del tornillo cefálico, aunque puede suceder a nivel del tornillo distal o a lo largo de la diáfisis entre los 3 meses y los 2 años (173,174,177,178,182,(196)(197)(198).…”

“…• Reducción insuficiente: que favorece un retardo de consolidación. Se debe optimizar el punto de entrada para evitar el varo proximal (199) y realizar compresión adecuada del foco de fractura (164).…”

“…• Carga precoz (? ): reportada por algún autor (199), aunque no parece que pueda influir según otros (203)(204)(205).…”