Long Gamma Nail Stabilization of Pathologic and Impending Pathologic Femur Fractures

Thirteen long Gamma nails were utilized without adjunctive bone cement in 11 patients for stabilization of 12 impending pathologic fractures and 1 pathologic fracture in the setting of metastatic disease (10 femora) and fibrous dysplasia (3 femora) of the proximal femur. Each femur was reamed to 18 mm proximally and 13 mm distally to accept the 17-mm diameter proximal portion and the 11-mm distal portion of the nail. Mean operative time was 104 minutes (range 60–237 minutes). Mean estimated blood loss was 304 cc (range 100–1,000 cc). All but one of the patients were allowed immediate full weight bearing on the operative limb. Overall International Society of Limb Salvage (ISOLS) ratings were excellent following seven procedures, good following five procedures, and poor following one procedure. Good to excellent pain relief was achieved following 11 of the 13 procedures. Either improved ambulatory capacity or good to excellent pain relief was achieved following 12 of the 13 procedures. Improvement by at least one ambulatory level was seen in 8 of 11 patients and following 10 of 13 procedures. One significant intraoperative complication, comminution of the already severely compromised intertrochanteric region, was encountered in one patient with metastatic lung carcinoma. The long Gamma nail has the advantages of percutaneous insertion through the tip of the greater trochanter, secure fixation in the proximal femur, and the ability to allow early weight-bearing ambulation. These advantages make it a desirable implant for stabilization of pathologic and impending pathologic femur fractures.