Published: 2022-02-25

Functional outcome of peritrochanteric fracture fixation with modified gamma nail using tri-wire anchorage

Jayanta Mukherjee, Mujatba Ahmad, Swagatam Jash, Kartick Nasipuri, Pankaj K. Kushwaha


Background: Pertrochanteric fractures comprise almost 50% of all proximal femoral fractures. Being common in elderly people, the quality of life deteriorates until the fracture is stabilized, followed by early mobilization. Intramedullary devices have been proven to improve biomechanics. In our study, we adopted modified gamma nail with additional tri-wire anchorage construct, which further stabilizes the rotational torque.

Methods: A prospective study was undertaken on 39 skeletally mature patients of both sexes, with per-trochanteric fracture, from January 2019 to April 2020. The study included 23 females and 16 males. the 34 underwent CRIF while 5 underwent ORIF. One patient was lost to follow-up. Clinico-radiological evaluations of the patients were done for 12 months. Functional evaluation was based on the modified Harris hip score (mHHS). Statistical analysis was done by SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism version 5. 

Results: The study showed 100% union rate. Radiologically at 3 months, the fracture united in all patients. At 6 months postoperatively all patients were ambulatory with or without walking aids. One patient had tri-wire cut through and one had tri-wire back-out. HHS was an average of 79 at 3 months representing a fair outcome. This increased to 90 at 6 months representing an excellent outcome.

Conclusions: Modified gamma nail with tri-wire anchorage has distinct advantages over other techniques. It allows for early weight-bearing and mobilization with lesser complications. The tri-wire construct further provides additional rotational stability in osteoporotic bone.

nal stability in osteoporotic bone.


Per-trochanteric fracture, Modified gamma nail, Tri-wire anchorage

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