Destabilization of intramedullary fixation with Gamma nail for intertrochanteric fractures with sliding screw cut out Destabilizacja śródszpikowego zespolenia gwoździem Gamma złamań przezkrętarzowych z migracją śruby doszyjkowej do stawu biodrowego

Introduction. Intertrochanteric fractures are located in the proximal upper part of the femur, extracapsulary and extend up to 5 cm under the minor trochanter (3). Intramedullary fixation is used almost exclusively for this kind of fractures in our department for many years. The most common mechanical complication of intramedullary fixation is the cut out of the sliding screw trough the femoral head. The most common reasons for fixation instability are unstable type of fracture, not anatomic fracture reduction and abnormal position of the sliding screw (4, 6). Patients with intertrochanteric fractures are usually operated in the early days of the hospital admission and diagnosis. Cut out of the screw is defined as the displacement of more than 1 mm beyond the contour of the femoral head. Aim. In our analysis we prove that destabilisation of gamma nail with cut out of sliding screw is caused by technical mistakes made during the surgical procedure. Material and methods. The analysis includes 763 patients who were operated with intramedullary fixation among 842 patients with a diagnosis of intertrohanteric fracture between 2008-2012. Results. Complication involving migration of the sliding screw was observed among the 12 patients. Conclusions. Complication according to literature was associated with: difficult, unstable type of the fracture, non anatomical reduction of the fracture and non-optimal position of the sliding screw.