A new addition to the third-generation Gamma nail system

The third generation Gamma trochanteric nail (Stryker Howmedica, Rutherford, NJ) is a commonly used device for internally fixing intertrochanteric fractures. Despite improvements made from the first and second generation Gamma trochanteric nail, the Gamma3 system has a high cut-out rate. To minimize cut-out, the U-blade (Stryker Howmedica, Rutherford, NJ) was designed as an addition to the Gamma3 system. We reviewed the literature regarding hip-screw cut-out, the Gamma nail, and the U-blade. We also report our operative technique and experience with the U-blade. Hip screw cut-out has been reported to occur in 2-8% of all patients receiving the Gamma3 trochanteric nail. A biomechanical study has reported that the addition of the U-blade decreases cut-out. Operative time is minimally affected, and the U-blade is easy to insert. The U-blade may reduce hip screw cut-out, but to our knowledge no clinical studies have been reported to show that it has lower cut-out rates than the current systems.