Femoral nailing is an attractive option for the treatment of hip fractures. This is a minimally invasive technique only requiring small incisions of the skin and does not require the large dissection needed for other techniques.
A metal rod (or nail) is placed within the femur, spanning across the fractured segment and is secured into place, most of with screws. One thicker screw is placed through the femoral neck and into the femoral head near the hip joint to prevent the fracture from rotating and compress across the fracture site, and one screw is placed near the end of the rod to prevent it from migrating inside the bone.
Patients are immediately able to walk after surgery because the metal rod helps to share the load of weight through the femur. This way patients can mobilize early, prevent the development of blood clots or a pneumonia and return to their pre-injury level of function and activity.
Hip Fracture Surgery
The primary goals of hip fracture surgery are twofold: decrease the pain associated with the fractured femur bone, but more importantly get patients back to walking. Historically, the treatment of fractures of the femur required the use of plates and screws to stabilize the fracture. But this approach requires a larger incision and dissection and does not allow for early weightbearing because it would cause the screws and/or plate to break.
While the idea for placing an implant within the hollow canal inside a bone has been around since the 1940s, it was not until the end of the 20 th century that designs were improved on and femoral nailing became a viable and attractive option for treating hip fractures. Femoral nailing has also been shown to have shorter surgical times and lower infection rates.
Hip fractures are one of the most common surgically treated fractures of the lower extremity in the United States and are most likely to be seen in elderly people after a fall from standing. While they are low energy fractures that happen due to poor bone quality, they can prevent patients from being able to walk and can lead to blood clots of the legs or pneumonias due to the inability to sit upright.
Xrays will be taken to diagnose hip fractures and it is recommended that these fractures are treated with surgery, most preferably within 48 hours of the injury.
The Gamma nail was first used in 1985 and the design has been improved upon over the years. A small incision is made lateral portion of the buttocks and the nail is inserted inside the femur. Attached to the device is a guide that ensures that the trajectory of the screws placed thought the middle of the nail is correct.
Two additional small incisions are made so that the screws securing the nails position can be placed. The nail itself is made from specially treated titanium that comes with multiple options to best fit the anatomy of the patient’s femur.
The larger screw placed through the nail and into the femoral head helps control compression and can help lessen shortening of the femoral neck seen after treatment with other devices (such as the dynamic hip screw). There is an additional screw at the top of the nail that can prevent any rotation at the fracture site which is a common problem when using other systems.