Long Gamma nail versus short Gamma nail in the treatment of stable intertrochanteric fractures: Is it worth it? A cost benefit analysis and a systematic review

Background: The short Gamma nail (Stryker, Mahwah, NJ) is a commonly used device for the treatment of stable intertrochanteric hip fractures. First generation Gamma nails have been complicated by fractures at the tip of the nail. The long Gamma nail has been shown to reduce the incidence of periprosthetic fractures. The purpose of this metaanalysis was to compare the cost-effectiveness of the long Gamma nail as an alternative to second and third generation short Gamma nails as the initial treatment of stable intertrochanteric fractures. Methods: Using MEDLINE via PubMed, all articles published in the English language between January 2000 and May 2007 that included the key words "trochanteric gamma," "long gamma," "hip," "intertrochanteric," and "gamma" were reviewed. A manual search of the reference list of each paper also was performed. Five papers fit these criteria. Gross costs were estimated from Medicare reimbursement data for the relevant Diagnosis-Related Group codes plus published costs for Current Procedural Terminology code. Results: Three hundred and twenty-nine short Gamma nails implanted were reviewed, and a total of two periprosthetic fractures were reported. Cost analysis demonstrated that a total cost of acute care hospitalization and a year of rehabilitation equals an additional $26,076,659.80 for the treatment of periprosthetic fractures with short Gamma nails as compared with the projected cost of initially treating primarily with long Gamma nails. Conclusions: The periprosthetic fracture rate of short Gamma nails in this meta-analysis suggests that the use of the long Gamma nail as the primary treatment for all stable intertrochanteric hip fractures is a cost-effective treatment.