Complications and technical problems with the gamma nail.

A retrospective review of complications with the gamma nail has been carried out in 152 patients with stable and unstable pertrochanteric fractures. Operative complications occurred in 10 patients. Screws penetrated the femoral neck in 3, immediate varus was associated with a short screw in 2, diaphyseal fractures occurred at the site of the distal screws in 3 and comminuted femoral fractures in 2. Fifteen patients (10.5%) died in hospital. At follow up, pseudarthrosis was present in 2 cases and fractures of the femoral shaft in 4. The incidence of complications could be reduced by using of shorter nails, less valgus angulation and by not introducing distal screws unless essential.