Risk factors for cut-out failure of Gamma3 nails in treating unstable intertrochanteric fractures: An analysis of 176 patients

Shang Wen Tsai, Chien Fu Jeff Lin, Yun Hsuan Tzeng, Chun Cheng Lin, Ching Kuei Huang, Ming Chau Chang, Chao Ching Chiang

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)


Background Cut-out failure is one of the most common complications in the Gamma3 nail fixation system. The purpose of this retrospective study was to determine pre-operative or intra-operative risk factors for cut-out failure of lag screws in unstable, intertrochanteric fractures fixed with short Gamma3 nails. Methods One hundred and seventy-six patients over 60 years of age, with unstable intertrochanteric fractures (AO/OTA 31-A2, 31-A3) treated with short Gamma3 nails were included in this study. All patients completed a minimum of 1-year follow-up. Analysis of post-operative radiographs included assessment for cut-out failure of lag screw, appropriateness of the entry point, posterior lag screw axis, fracture gaps, posterior displacement of the proximal fragment, and tip-apex distance. Results Of the 176 patients in this study, 22 patients were identified with cut-out failure. Multivariate logistic regression analysis revealed that improper entry point in an antero-posterior projection (odds ratio 10.39, 95% confidence interval 1.74–78.4), posterior displacement distance of the proximal fragment in a lateral projection (odds ratio 1.35, 95% confidence interval 1.17–1.59), and female sex (odds ratio 17.14, 95% confidence interval 1.88–876.11) were correlated with cut-out failure. Conclusion This study emphasizes the importance of an optimal position of reduction in the lateral projection in reducing the risk of cut-out failure. In addition, sex difference in bone mineral density, proximal femur geometry, and the bone strength in elderly females may explain why female sex is a risk factor.

Original languageEnglish
Pages (from-to)587-594
Number of pages8
JournalJournal of the Chinese Medical Association
Issue number9
Publication statusPublished - Sept 2017


  • Cut-out
  • Failure
  • Gamma nail
  • Intertrochanteric fracture
  • Risk factor

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Risk factors for cut-out failure of Gamma3 nails in treating unstable intertrochanteric fractures: An analysis of 176 patients'. Together they form a unique fingerprint.

Cite this