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30 Jun 2023
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Failure of fixation - Gamma nail cut-out and arthroplasty revision

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Clinical Details

Clinical and radiological findings:  Comminuted per/- subtrochanteric fracture with displaced GT/lateral wall fragment. O significantly underestimated this fracture preoperatively.

Preoperative Plan

Planning remarks:  Plan was a nail, stubbornly stuck with doing a nail

Surgical Discussion

Operative remarks: 

Mini-open reduction with a colinear reduction clamp, and stabilisation with a single cerclage cable. all rather tenuous but seemed to sit ok. Inital reduction was somehow lost between lining up the jig and placing the neck screw - resulting in slight varus and proximal screw position in the head - both independent risk factors for subsequent cut-out.

Postoperative protocol:   Full weight bearing as tolerated. Implant failure occured around 3 weeks post-op.

Orthopaedic implants used:   Gamma 3. Revised with a Zimmer Alloclassic Zweymüller (SLL Stem, Stepless Long)

Author's Resources & References

https://pubmed.ncbi.nlm.nih.gov/37216568/

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Dr Ed Oates
  • Germany , Schleswig Holstein
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
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