Trochanteric gamma nail vs proximal femoral nail for pertrochanteric fractures: A comparative study

Aim: We have performed a retrospective comparative study between the trochanteric gamma nail (TGN) and the proximal femoral nail (PFN). Method: During the period 1998-2003, 97 TGN and 83 PFN were used for the treatment of pertrochanteric fractures. Most of the fractures were of the A3 type according to the AO/ASIF classification. Clinical and radiological follow-ups were available for 87 TGN and 65 PFN. Results: The mean operative time for the TGN was shorter than that for the PFN. Intraoperative complications were noted in 17.5% and 28.8% for the TGN and PFN groups, respectively. Late complications occurred in 18.4% for TGN compared to 27.6% of the PFN. Union was achieved in 94.2% and 89.3% of the patients treated with the TGN and PFN, respectively. The reoperation rates were 10.3% and 24.6% for the TGN and the PFN, respectively. Clinical outcomes were good for both groups (65% in the TGN, 62% in the PFN group). Conclusion: Treatment of pertrochanteric fractures using the TGN and PFN implants is quite reliable. The major complication was cut-out and occurred mostly in the PFN group, while varus deformity was more frequent in the TGN group. The PFN was associated with a higher rate of reoperation and longer operative time, probably due to a more demanding technique.