A comparative prospective study of dynamic variable angle hip screw and Gamma nail in intertrochanteric hip fractures UMBERTO TARANTINO 1 , FRANCESCO OLIVA 1 , ANGELO IMPAGLIAZZO 2 , ANTONIO MATTEI 2 , GIUSEPPE CANNATA 1 , GIAN FRANCESCO SPURIO POMPILI 2 , & NICOLA MAFFULLI 3 1 University of Rome ‘‘Tor Vergata’’, Faculty of Medicine and Surgery, Department of Orthopaedics and Traumatology, Rome, Italy, 2 Orthopaedic Trauma Center, Fourth Department of Orthopaedic Trauma, Rome, Italy, and 3 Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, North Staffordshire Hospital, Stoke on Trent, Staffordshire, UK Abstract Purpose: To compare the results between a variable angle dynamic screw-plate(DMS) and the Gamma nail in the treatment of intertrochanteric hip fractures. Methods: A comparative prospective study of 142 patients (AO/OTA Type 31-A1; A2; A3 and B2) treated by variable angle dynamic screw-plate (DMS Group = 71) or by intramedullary nailing (Gamma Nail Group = 71). Results: At the 12-month follow-up, we did not find any statistically significant difference, intraoperatively, radiographically, or clinically, between the two groups of patients, except for shortening. In 12 patients in the DMS group (17%) and in one patient in the Gamma nail group, there was shortening of the operated leg between 1 cm and 3 cm (p = 0.02). In all instances, shortening occurred in patients who sustained A.O. type fractures 31A2. 2 and 3 (19 patients), which are unstable and comminuted. Conclusions: The DMS allows effective management of intertrochanteric fractures of the femur. Surgeons should consider choosing surgical treatment according to the type of intertrochanteric fracture. In less comminuted fractures, a compression hip screw may be a faster and safer surgical solution. In comminuted fractures, surgical difficulties may increase in parallel to fracture complexity. Keywords: Intertrochanteric hip fractures, variable angle hip screw, Gamma nail Introduction Recently, population ageing has resulted in an epidemic of proximal femoral fractures [1 – 5]. These patients may have associated medical problems which make their management more challenging. Intertrochanteric hip fractures require timely man- agement to provide sound stabilization of the fracture, allowing early mobilization preventing the complications of prolonged immobilization [6,7]. In these fractures, extramedullary or intramedul- lary fixation has been advocated [8]. This study compares extramedullary and intramedullary fixation using a dynamic hip screw with variable angle or the Gamma nail. To our knowledge, these two devices have never been compared. Also, we are not aware of any clinical study reporting the outcome of patients with intertrochanteric femoral fractures managed with this particular extramedullary device. Patients and methods All the procedures described in this article were approved by the local ethics committee. All patients gave written informed consent to take part in the study. We recruited in the study patients with an Correspondence: Nicola Maffulli, Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, North Staffordshire Hospital, Thornburrow Drive, Hartshill, Stoke on Trent, Staffordshire, ST4 7QB, UK. Tel: + 44 1782 554 608. Fax: + 44 1782 412 236. E-mail: n.maffulli@keele.ac.uk Disability and Rehabilitation, 2005; 27(18-19): 1157 – 1165 ISSN 0963-8288 print/ISSN 1464-5165 online ª 2005 Taylor & Francis DOI: 10.1080/09638280500055875