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Mark A. Leberte, MD, The Orthopaedic
Center, Huntsville, AL
Intertrochanteric hip fractures
comprise approximately 50% of all hip fractures, and the incidence
is rapidly increasing as our population ages. Although without
question, the sliding compression hip screw remains the gold
standard for the treatment of this injury, the intramedullary
hip screw offers an attractive, efficient alternative. Many
of the early complications seen with the first generation
intramedullary hip screws have been obviated by design and
technique modifications. Potential advantages include the
intramedullary location, therefore becoming a load-sharing,
and subsequently, more stable device. The shorter lever arm
results in decreased tensile implant strain. The closed procedure
performed without opening the fracture site maintains the
fracture environment and affords all the benefits of maintaining
the "fracture milieu." Smaller incisions can equate
to less blood loss, shorter operative times, and the potential
for less wound morbidity. It is probably the implant of choice
in reverse oblique and some subtrochanteric fractures. Our
experience with the Gamma nail is presented along with our
results and complications. Case examples are used to highlight
some of the technical aspects of the procedure.
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