Gamma 3 Long Nail for Complex Sub-Trochanteric Fractures: A Ten-Year Retrospective Study

Research Article

Austin J Musculoskelet Disord. 2021; 8(1): 1060.

Gamma 3 Long Nail for Complex Sub-Trochanteric Fractures: A Ten-Year Retrospective Study

Urso R1, Milani L1*, Ortolani A1, Martucci A1, Berti M1, Pascarella R2 and Tigani D1

¹Department of Trauma and Orthopaedic Surgery, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy

²Department of Trauma and Orthopaedic Surgery, Ospedali Riuniti di Ancona, Ancona, Italy

*Corresponding author: Milani L, Department of Trauma and Orthopaedic Surgery, Ospedale Maggiore Carlo Alberto Pizzardi, Largo Nigrisoli 2, 40133 Bologna, Italy

Received: September 20, 2021; Accepted: October 19, 2021; Published: October 26, 2021


Cephalomedullary nailing is considered the treatment of choice for trochanteric and subtrochanteric femoral fractures. The aim of this study was to report postoperative outcomes of one of the widely used trochanteric nail device, the Gamma 3 long nail. We retrospectively assessed 405 patients treated with Gamma 3 long nail in a single Level One Trauma Centre between 2010 and 2018. We finally included 261 ambulant patients with 65 years or older, a lowenergy trauma and a closed trochanteric or subtrochanteric femoral fracture. Clinical outcomes were evaluated using the Hip Fracture Functional Recovery Score (FRS), while radiological complications and failures were assessed on postoperative x-rays.

More than two-thirds of patients had completed fracture consolidation within 4 months after surgery. Immediate full weight bearing was allowed postoperatively in 64.0% of patients. We reported a mortality of 24.5% at one year postoperatively. The leading clinical postoperative complication was anemia (69.3%), followed by deep venous thrombosis (7.7%). Coxa vara was observed in 73 patients (28%), followed by malreduction in flexion-external rotation of the proximal femoral fragment (26.8%). No case of lag screw cutout was reported. Our study indicated that last generation of Long Gamma nail is a reliable implant for trochanteric and subtrochanteric femoral fractures in the elderly patients, leading to high rate of bone union and reduced incidence of related complications. An excellent fracture reduction and prevention of postoperative varus malalignment are the main factors that can avoid the major postoperative complications and failures after Gamma 3 long nailing.

Keywords: Gamma 3 long nailing; Subtrochanteric femoral fractures; Complex trochanteric fractures; Complications; Failures; Clinical outcomes


LGN: Long Gamma Nail; FRS: Hip Fracture Functional Recovery Score; ROC: Radius of Curvature; ASA: American Society of Anesthesiologists; BADL: Basic Activity of Daily Living; IADL: Instrumental Activity of Daily Living; Max: Maximum; N.: Number; ext.: External-Rotation; fem.: Femoral


Gamma nail was developed for the treatment of trochanteric hip fractures in the mid 1980’s and was first brought into clinical use in 1988 [1].

Long Gamma Nail (LGN) was introduced some years later in 1992 for the treatment of subtrochanteric fractures, femoral shaft fractures and combined trochantero-diaphyseal fractures of the femur. The later implant has experienced further changes in 1997, 2003 and 2018 [2].

The second generation of LGN was introduced in 1997 with reduced medio-lateral curvature from 10o to 4o and modifications of proximal and distal caliber in a single diameter of 17 and 11 mm respectively [3]. In 2003 appeared the long Gamma 3 nail [2]. In contrast with the previous one, The Radius of Curvature (ROC) of the femoral nail was reduced to 2.0m to match the femoral bowing. Others change concerned the introduction of a titanium alloy with anodized surface treatment for the implant, the reduction of the proximal diameter to 1.5m, and the modification of both proximal lag screw and distal locking screws [4].

The purpose of this study was to report the treatment results of complex trochanteric and subtrochanteric femoral fractures in the elderly patients with last generation of Long Gamma nail and determine the rates and the time of consolidation, all implant-related complications and patient mortality.

Materials and Methods

A retrospective analysis of all patients treated with a Gamma 3 Long Nail (Stryker) was performed in a single Italian Trauma Centre within a ten-year period (between January 2009 and December 2018).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee “Area Vasta Emilia Centro” (CE-AVEC) of the Medical University of Bologna.

Informed consent was obtained from all individual participants included in the study. All patients signed informed consent regarding publishing their data and photographs.

At a first search we found 405 patients. The inclusion criteria for this study were patients 65 years of age or older with trochanteric (AO/ASIF 31-A), subtrochanteric (AO/ASIF 32-A) or combined trochantero-diaphyseal fractures (Table 1).