Gamma 3 pinpoint is a wide spread intramedullary device for fixation of per trochanteric fractures. Cut out of the lag screw is the most common complication of this implant. We present a 62-year-old female patient, who underwent a entire hip arthroplasty following cut out of a Gamma 3 nail in the femoral neck. The cause of the cut out in our case is actually unique. Our intraoperative findings accompanied with the radiographic evaluation argue that the malposition of the laid fuck was the causal agent of bankruptcy, due to the rotational instability of femoral head-lag screw whole. We present this case with detail description, highlighting the proper consumption of this specific collar and appose a brief literature revue. Keywords:

Gamma 3 nail, Cut out failure, Set screw malposition, Head-screw rotation, Intertrochanteric fracture

1. Introduction

Gamma 3 Nail ( Trochanteric Nail 180 ; Stryker Trauma GmbH, Schoenkirchen, Germany ) is a wide spread and well-established intramedullary device for obsession of per trochanteric fractures. cranial cut out of the lag fuck is the most common complication of Gamma 3 fixation system with incidence ranging from 1.6 % to 4.3 %. 1 Concerning the surgical technique, the already known main causes and hazard factors for this complication are the following : not anatomic reduction of the fracture, suboptimal slowdown screw placement and improper submission point. 1, 2 In this subject, we describe a unique cause of cut out failure of Gamma 3 collar, which to our cognition, has never been reported before. Set screw malposition has never been considered as a cause of lag screw cut out, although the indocile rotation of head-lag screw unit can cause catastrophic bankruptcy of the reconstruct. We present the case with details, we describe methods to recognize rotation of head-lag screw unit, we highlight the proper use of the implant and ultimately we appose a brief literature review .

3. Discussion

Concerning the Gamma 3 device the reported risk factors for cut out failure due to suboptimal manipulation of the device are the improper entrance target, the non-optimal stave screw position 1 and the inadequate three-point slowdown cheat arrested development, 3 but no mention exists regarding the improper sic screw placement. In this case report we present a unique catastrophic failure of a Gamma 3 breeze through due to a malposition of the set screw. To best of our cognition, this causal agent of Gamma 3 failure has never been reported in the literature. Although, in this case there are several extra factors that are probably to contribute to this manufacture failure and should decidedly be taken into consideration. The comorbidities of the patient ( insulin-dependent diabetes mellitus, kidney failure ) can compromise the bone quality and this can affect the bone-lag sleep together concept. In addition, early potential patient or surgeon related issues except bone quality are : the early burden bearing, the smaller pinpoint diameter and the toggle of the plant due to the distal engage screw loosening. During Gamma 3 implantation it is very crucial to insert the fructify fuck in one of the four grooves ( ) of the lag screw, to avoid rotation of the femoral head-lag screw whole and then the dress screw should be slenderly tightened ( inactive interim sleep together ). Afterwards, the plant screw should be unscrewed by one quarter of turn to allow lateral skid ( moral force set screw ). At this sharpen, rotation of the stave sleep together should be checked with the appropriate screwdriver. If the dress screw is out of the groove, even one stern of turn can lead to rotational instability and bankruptcy, as in our case. There is consensus that set screw utilization is obligatory, although recently controversy exists if the sliding effect of the head-screw whole is beneficial. There are studies, 4, 5 which support not to unscrew the hardening screw to avoid the sliding impression, which has been correlated with leg length discrepancy, poorer functional outcomes and cut-out phenomenon. 4 The results of a randomized control trial concerning the dynamic or static lag screw shape of Gamma 3 nail down would be very interesting. 5 rotation in femoral head-screw unit exists tied in cases with proper surgical proficiency and this has been proven with biomechanical studies. 6, 7 rotation of the head-screw unit of measurement may be the mechanism of obsession failure of per trochanteric fractures treated with intramedullary nails, 8 although the demand mechanism has not been adequately investigated sol far. Surgeons should be able to recognize the risk factors predisposing to this failure mechanism. Basicervical fractures, A3 AO/OTA proximal femoral fractures with extension of the fracture credit line to the femoral neck, suboptimal lag screw status and inadequate fracture reduction are considered as the main risk factors for rotational instability of femoral head-lag fuck whole. These types of fractures may require an anti-rotational element, although far research is urgently needed, 8 while center to center position of the imprison screw minimize the rotation of the femoral read/write head and prevents cut out. 6

4. Conclusions

Flaws in surgical proficiency concerning nail of intertrochanteric fractures can lead to devastating complications and failure. revision operation of fail cases is technical demand and is associated with many complications. Trauma surgeons should be able to choose the allow implant for each affected role and to use it besides properly. Trauma surgeons should be mindful of this possible campaign of Gamma 3 failure and hard-and-fast attachment to surgical technique is mandatary to avoid this annihilative “ iatrogenic ” failure. orthopedic surgeons should besides be able to recognize signs of rotational instability of such fractures a soon as possible.


This research did not receive any specific concede from funding agencies in the public, commercial, or nonprofit organization sectors .

CRediT authorship contribution statement

Ioannis Papaioannou: Conceptualization, Writing – original draft. Thomas Repantis: Conceptualization, Project administration. Panagiotis Korovessis: Writing – review & edit, Visualization, Supervision .


We thank the affected role for providing accept for this character report .

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