Hip fractures are one of the most common surgically treated fractures of the lower extremity in the United States...
Evolution of Femoral Nailing
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.
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.