Peritrochanteric Fractures of the Femur: A Comparison between the Ender Nail, Gamma Nail and Dynamic Hip Screw

Surgical fixation, early weight-bearing, and bony union remain a challenge in the treatment of peritrochanteric femur fractures, especially if the fractures are comminuted or unstable. A randomized prospective study of 154 fractures treated by either the Gamma nail (43), Dynamic Hip Screw (DHS) (30) or Ender's nail (81) is reported. The average follow-up for Ender's nails was 36.7 months; for DHS 39.4 months and for Gamma nails 37.3 months. The Ender's nails required a significantly (p<0.001) shorter operation time of 42±13.4 min. The Gamma nail group required a higher mean duration of screening, 193±92 sec. Few screws in either group were in a bad position, but 12 (32%), in the Gamma nail group, and 2 (10%) in the DHS were placed superiorly in the head. From this experience, the Gamma nail appears to allow for early patient ambulation regardless of the fracture configuration with good clinical results, but the potential advantages of the Gamma nail are still unclear in these already compromised patients.