Pertrochanteric fractures are the most frequent
type of proximal femur fractures. The main objectives of surgical
treatment are early mobilization and full weight bearing.
A good knowledge of the factors related to failure of the implant
is necessary to avoid them. The most important is the
cephalic screw positioning because it is most dependent on
surgical technique. We present a retrospective study about
the cephalic screws positioning in 400 pertrochanteric fractures
treated with gamma nail. We also assessed the tip-apex
distance and impaction of the fracture, looking for any relationships
between them and the failure of the implant. In our
series, 37.7% of screw failures occurs in the anterior-superior
localization, and 30.7% in posterior-inferior localization. All
cut-outs were produced in cases with a Tip Ápex distance larger
than 28 mm. The mean impaction in stable fractures was
2.27 mm and in unstable fractures was 8.26 mm.

Pertrochanteric fractures are the most frequent
type of proximal femur fractures. The main objectives of surgical
treatment are early mobilization and full weight bearing.
A good knowledge of the factors related to failure of the implant
is necessary to avoid them. The most important is the
cephalic screw positioning because it is most dependent on
surgical technique. We present a retrospective study about
the cephalic screws positioning in 400 pertrochanteric fractures
treated with gamma nail. We also assessed the tip-apex
distance and impaction of the fracture, looking for any relationships
between them and the failure of the implant. In our
series, 37.7% of screw failures occurs in the anterior-superior
localization, and 30.7% in posterior-inferior localization. All
cut-outs were produced in cases with a Tip Ápex distance larger
than 28 mm. The mean impaction in stable fractures was
2.27 mm and in unstable fractures was 8.26 mm.