The treatment of stable and unstable proximal femoral fractures with a new trochanteric nail: results of a multicentre study with the Veronail

Abstract

The incidence of hip fractures continues to rise. This study is the first evaluation of a new intramedullary implant, the Veronail, that provides double axis fixation into the femoral head and allows the surgeon to choose whether to use sliding or fixed locked proximal screw fixation for trochanteric femoral fractures. The fractures were classified according to the AO classification, and function was assessed with the Modified Harris Hip Score. 111 patients with trochanteric fractures were evaluated in eight Italian hospitals. The stable 31.A1 fractures were treated with sliding proximal screws, the subtrochanteric 31.A3 fractures with converging proximal screws, and the unstable 31.A2 fractures were treated with both types of proximal fixation. The unstable fractures treated with locked converging screws had the same function at one year as those treated with sliding screws. This study suggests a possible new method of treating unstable trochanteric femoral fractures. This may be the solution to prevent excessive collapse of the fracture with the resultant poor function and persisting pain noted in the literature. Two converging locked proximal screws seem to provide stable fixation in 31.A2 femoral fractures and produce as good a result as the use of traditional sliding screws. The role of converging locked proximal screws in unstable trochanteric fractures requires further evaluation.

Retrospective critical analysis of treatment of closed extra capsular proximal Femur fractures with proximal femur nail at rural teaching setup

“…I evaluated results and compared them with those obtained from various published studies. In my study, proximal femur fractures were more common after 5th decade with a mean age group of 56.4 years where as in the studies of Franco et al (2008) [24] , Shan-Wei Yang et al (2012) [25] and Bhakat et al(2013) [26] who had an mean age of 79.3 years, 53 years and 67.8 years respectively. The sex ratio as per this study was male: female=2.3:1.…”

“…Out of 60 patients, there were 42 male (70%) patients and 18 female (30%) patients. While in Franco et al (2008) [24] and Bhakat et al (2013) [26] study, more patient were female 81 out of 111 (73%), and 17 out of 30 (60%) respectively. In our study increased incidence in male as compare to female is due to their involvement in riding vehicles, heavy agriculture, labour and more outdoor activities.…”

“…Both of these cases were satisfactorily managed by parenteral antibiotic and regular dressings. While in Franco study (2008) [24] , Shan-Wei Yang study (2012) [25] and Bhakat and Ranadeb study (2013) [26] , there were no infection. This is probably due to poor hygiene condition of our patients.…”

A Comparison of the Long Gamma Nail with the Sliding Hip Screw for the Treatment of AO/OTA 31-A2 Fractures of the Proximal Part of the Femur

“…That study contained no control arm, and as a result one is not able to draw conclusions with regard to the optimum treatment of this fracture pattern. In a study evaluating the VeroNail (Orthofix, Verona, Italy) with locked converging screws, patients with unstable proximal femoral fractures had the same function as those managed with a sliding hip screw 19 .…”

The treatment of intertrochanteric fractures of the femur with Endovis nail

“…Three cases of cut-out, associated with malposition of the proximal lag screws, occurred with the ENDOVIS nail. In a study of Veronail, another nail, Lavini et al [31] observed screw cut-out in 4.5% of cases. In our study, the lag screw was inserted close to the subchondral bone, and the hip pin superior to the femoral head.…”