{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:29:27Z","timestamp":1790666967626,"version":"4.1.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2017,9,25]],"date-time":"2017-09-25T00:00:00Z","timestamp":1506297600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS OA"],"published-print":{"date-parts":[[2017,9,28]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The purpose of this study was to evaluate the rates of implant-related complications and mortality after treatment of an intertrochanteric or subtrochanteric fracture with a short or long Gamma nail.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Between September 1998 and August 2003, 644 patients at 2 centers treated with a long or short Gamma nail for a hip fracture were prospectively enrolled in this study. These patients were followed until they reached 1 of the study end points, which included death, a reoperation directly related to the Gamma nail, or the end date of the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The average age (and standard deviation) of the patients included in the study was 81.3 \u00b1 8.6 years at the time of the operation, and 28.3% of the patients were male. The rate of implant-related complications was 9.9%. The most common complications included peri-implant fracture (4.2%), proximal lateral thigh discomfort requiring extraction of the implant (2.0%), and lag-screw cutout (1.1%). Interestingly, more than half (56%) of the 27 peri-implant fractures occurred &gt;1.5 years after the index operation. The median time from the operation to death was 2.9 years (range, 0 to 17.1 years). The 30-day mortality rate after treatment was 9.5%. Patients with American Society of Anesthesiologists (ASA) class-3 or 4 physical status had a significantly higher risk of mortality than ASA class-1 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Gamma nails are effective in the treatment of intertrochanteric and subtrochanteric fractures. However, 9.8% of patients had complications requiring additional surgery. The most common serious complications include peri-implant fracture and lag-screw cutout. Several peri-implant fractures occurred long after the index procedure. Patients had a high rate of mortality (27%) after 1 year, and higher preoperative ASA class was found to be a predictor of increased risk of mortality. Therefore, clinicians must carefully consider patients\u2019 preoperative comorbidities when counselling patients on the risks of surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.17.00026","type":"journal-article","created":{"date-parts":[[2017,9,22]],"date-time":"2017-09-22T18:38:14Z","timestamp":1506105494000},"page":"e0026","source":"Crossref","is-referenced-by-count":42,"title":["Implant-Related Complications and Mortality After Use of Short or Long Gamma Nail for Intertrochanteric and Subtrochanteric Fractures"],"prefix":"10.2106","volume":"2","author":[{"given":"Nolan S.","family":"Horner","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Samuelsson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janos","family":"Solyom","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Orthopaedic Surgery, \u00d8stfold Hospital Trust, Fredrikstad, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Bj\u00f8rgul","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, \u00d8stfold Hospital Trust, Fredrikstad, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olufemi R.","family":"Ayeni","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7297-0423","authenticated-orcid":false,"given":"Bengt","family":"\u00d6stman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, \u00d8stfold Hospital Trust, Fredrikstad, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,9,25]]},"reference":[{"issue":"11","key":"R1-20230714","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s00198-004-1627-0","article-title":"An estimate of the worldwide prevalence, mortality and disability associated with hip fracture","volume":"15","author":"Johnell","year":"2004","journal-title":"Osteoporos Int"},{"issue":"4","key":"R2-20230714","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.injury.2008.10.001","article-title":"Results of non-operative treatment following hip fracture compared to surgical intervention","volume":"40","author":"Hossain","year":"2009","journal-title":"Injury"},{"issue":"6","key":"R3-20230714","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.arth.2010.04.010","article-title":"American Society of Anesthesiologist Physical Status score may be used as a comorbidity index in hip fracture surgery","volume":"25","author":"Bjorgul","year":"2010","journal-title":"J Arthroplasty"},{"issue":"1","key":"R4-20230714","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1302\/0301-620X.87B1.15295","article-title":"The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures. A randomised, controlled trial","volume":"87","author":"Miedel","year":"2005","journal-title":"J Bone Joint Surg Br."},{"issue":"2","key":"R5-20230714","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1302\/0301-620X.73B2.2005167","article-title":"Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the Gamma nail and the dynamic hip screw","volume":"73","author":"Bridle","year":"1991","journal-title":"J Bone Joint Surg Br."},{"issue":"3","key":"R6-20230714","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1177\/230949901302100309","article-title":"Cephalomedullary nail versus sliding hip screw for unstable intertrochanteric fractures in elderly patients","volume":"21","author":"Chua","year":"2013","journal-title":"J Orthop Surg (Hong Kong)"},{"issue":"2","key":"R7-20230714","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/j.1532-5415.1998.tb02534.x","article-title":"Mobility after hip fracture predicts health outcomes","volume":"46","author":"Fox","year":"1998","journal-title":"J Am Geriatr Soc."},{"issue":"3","key":"R8-20230714","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00264-009-0783-4","article-title":"A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures","volume":"34","author":"Liu","year":"2010","journal-title":"Int Orthop"},{"issue":"10","key":"R9-20230714","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1007\/s00402-004-0744-8","article-title":"Complications following the treatment of trochanteric fractures with the Gamma nail","volume":"124","author":"Hesse","year":"2004","journal-title":"Arch Orthop Trauma Surg"},{"issue":"5","key":"R10-20230714","doi-asserted-by":"crossref","first-page":"e96","DOI":"10.1097\/BOT.0b013e3182a7131c","article-title":"Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31-A1 and A2)","volume":"28","author":"Boone","year":"2014","journal-title":"J Orthop Trauma"},{"issue":"6","key":"R11-20230714","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1097\/BOT.0b013e318162f67f","article-title":"Gamma nails revisited: Gamma nails versus compression hip screws in the management of intertrochanteric fractures of the hip: a meta-analysis","volume":"23","author":"Bhandari","year":"2009","journal-title":"J Orthop Trauma"},{"issue":"1","key":"R12-20230714","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s002640050026","article-title":"Complications and technical problems with the Gamma nail","volume":"20","author":"Albareda","year":"1996","journal-title":"Int Orthop"},{"issue":"1","key":"R13-20230714","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/1471-2474-11-133","article-title":"3066 consecutive Gamma nails. 12 years experience at a single centre","volume":"11","author":"Bojan","year":"2010","journal-title":"BMC Musculoskelet Disord"},{"issue":"5","key":"R14-20230714","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/17453670810016588","article-title":"The Norwegian Hip Fracture Register: experiences after the first 2 years and 15,576 reported operations","volume":"79","author":"Gjertsen","year":"2008","journal-title":"Acta Orthop"},{"issue":"7529","key":"R15-20230714","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1136\/bmj.38643.663843.55","article-title":"Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study","volume":"331","author":"Roche","year":"2005","journal-title":"BMJ"},{"issue":"1","key":"R16-20230714","doi-asserted-by":"crossref","first-page":"E52","DOI":"10.1503\/cmaj.130901","article-title":"Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial","volume":"186","year":"2014","journal-title":"CMAJ"},{"issue":"7","key":"R17-20230714","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/BOT.0000000000000036","article-title":"Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years","volume":"28","author":"Kleweno","year":"2014","journal-title":"J Orthop Trauma"},{"issue":"3","key":"R18-20230714","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1097\/BOT.0000000000000521","article-title":"Costs and complications of short versus long cephalomedullary nailing of OTA 31-A2 proximal femur fractures in U.S. veterans","volume":"30","author":"Krigbaum","year":"2016","journal-title":"J Orthop Trauma"},{"issue":"4","key":"R19-20230714","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1016\/j.injury.2016.07.038","article-title":"Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study","volume":"47","author":"Caiaffa","year":"2016","journal-title":"Injury"},{"issue":"2","key":"R20-20230714","doi-asserted-by":"crossref","first-page":"97","DOI":"10.5435\/00124635-200702000-00004","article-title":"Intramedullary nailing of the lower extremity: biomechanics and biology","volume":"15","author":"Bong","year":"2007","journal-title":"J Am Acad Orthop Surg"},{"issue":"7","key":"R21-20230714","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/BOT.0b013e31827cd5bd","article-title":"Is distal locking necessary? A biomechanical investigation of intramedullary nailing constructs for intertrochanteric fractures","volume":"27","author":"Gallagher","year":"2013","journal-title":"J Orthop Trauma"},{"issue":"1","key":"R22-20230714","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2474-14-1","article-title":"Critical factors in cut-out complication after Gamma nail treatment of proximal femoral fractures","volume":"14","author":"Bojan","year":"2013","journal-title":"BMC Musculoskelet Disord"},{"key":"R23-20230714","article-title":"Institutional and seasonal variations in the incidence and causative organisms for post-traumatic wound infections and osteomyelitis after open fractures","author":"Sagi","year":"2016","journal-title":"J Orthop Trauma"},{"key":"R24-20230714","first-page":"143598","article-title":"Complications following treatment of trochanteric fractures with the Gamma3 nail: is the latest version of Gamma nail superior to its predecessor?","volume":"2014","author":"Georgiannos","year":"2014","journal-title":"Surg Res Pract"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01960901-201709000-00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:42:52Z","timestamp":1787751772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01960901-201709000-00007"}},"subtitle":["A Prospective Study with Minimum 13-Year Follow-up"],"short-title":[],"issued":{"date-parts":[[2017,9,25]]},"references-count":24,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.17.00026","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,25]]}}}