Inadequate 'three-point' proximal fixation predicts failure of the Gamma nail

  • S. G. F. Abram, T. C. B. Pollard, A. J. M. D. Andrade
  • The Bone & Joint Journal, May 2013, Bone & Joint
  • DOI: 10.1302/0301-620x.95b6.31018

Three-point proximal fixation prevents failure of the Gamma intramedullary nail in hip fractures

What is it about?

We hypothesised that mechanical failure of the Gamma intramedullary nail was associated with inadequate 'three-point' proximal fixation in proximal femoral hip fracture . A total of 16 failures (7.2%) were identified in 223 cases. The position of the lag screw relative to the lateral cortex was the most important point of proximal fixation, and when inadequate the failure rate was 25.8%. The other two points of fixation are also shown to be important to prevent failure.

Why is it important?

Introduces concept of three-point proximal fixation to prevent failure of the intramedullary nail devices. The contact point between the lateral end of the lag screw with the lateral femoral cortex is demonstrated to be the most important point - the first time this has been shown in the published literature - a practice changing finding.

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The following have contributed to this page: Simon G F Abram and Tony Andrade