The treatment of subtrochanteric nonunions with the long gamma nail -: Twenty-six patients with a minimum 2-year follow-up

Objective: To assess the efficacy of the long Gamma nail in the treatment of subtrochanteric nonunions. Design: Retrospective. Setting: Multicenter (university teaching hospital, private centers). Patients: Twenty-nine consecutive patients with noninfected subtrochanteric nonunions following fractures previously treated with different methods of internal fixation. Intervention: Implant removal, corrective osteotomy as needed (3 cases), fixation with a long Gamma nail, and cancellous bone grafting where bone loss (5 cases), all done in a 1-stage procedure. Main Outcome Measurements: Analysis of clinic and radiologic results. Outcome assessment comparing the preinjury status with the status at a minimum follow-up of 24 months. Results: At 2 years, 2 patients had died and another patient was lost to follow-up. Thus, 26 patients completed a median follow-up of 27 months (range 24-41 months). Twenty-three of these patients achieved union after 1 procedure (88% effective initial treatment), and 2 patients achieved union after 1 additional procedure each (exchange of a broken nail and bone grafting, respectively), rising the rate of union to 25 of the 26 patients (96%) in a mean of 7 months (range 4-11 months). The other patient remained ununited at the time of her final follow-up. In addition to the broken nail, breakage of the distal bolts occurred in 2 patients with less than 10 mm shortening. Twenty-one of the 26 patients (80.7%) were restored to their preinjury status. Conclusion: Subtrochanteric nonunion can be treated effectively using the long Gamma nail for skeletal stabilization, following removal of previously implanted devices.