A preliminary experience with a new intramedullary nail for trochanteric fractures

A preliminary experience with a new intramedullary nail for trochanteric fractures

Authors

  • Pietro Maniscalco Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Fabrizio Quattrini Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Corrado Ciatti Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Valeria Burgio Orthopaedic Surgery Department, SS Annunziata Savigliano Hospital, Savigliano (CN), Italy
  • Fabrizio Rivera Orthopaedic Surgery Department, SS Annunziata Savigliano Hospital, Savigliano (CN), Italy
  • Giovanni Di Stefano Orthopedics and Traumatology Department, University of Catania, Italy
  • Vito Pavone Orthopedics and Traumatology Department, University of Catania, Italy

Keywords:

Pertrochaneric fractures, Intramedullary nail, Silicon coating, D-Nail, COVID-19

Abstract

Background and aim of the work: The worldwide incidence of fractures of the proximal end of the femur is increasing as the average age of the population rises. The current surgical gold treatment standard is intramedullary nail fixation. The Authors present their experience with the D-Nail system for intertrochanteric femur fractures. Methods: From January 1st to February 21st 2020 (breakout of COVID-19 pandemic) 34 patients were treated with the D-Nail system: 11 with basicervical fractures, 16 with intertrochanteric stable fractures and 7 with intertrochanteric unstable fractures. In 11 cases, a single cephalic screw was used; in 23 cases, two of them were used. Distal locking was executed in 7 patients. Follow-up time ranged from 2 to 3 months. Results: None of the reported intra- or post-operative complication was linked to the fixation device or the surgical technique. Patients were monitored with clinical and radiological checkups using modified Harris Hip Score to accurately evaluate the fluctuations in the rehabilitation period. Conclusion: The main advantages of this synthesis device are the proximal hole’s peculiar shape, which allows the possibility to position one or two cephalic screws on the same nail, and the silicon coating, which provides numerous biological advantages. Distal locking was executed in selected cases only, based on fracture type. Optimum treatment involves rapid execution of surgery, minimal trauma during surgery, maximum mechanical stability, and rapid weight-bearing. Although our case number is small and follow-up time brief, our results are encouraging.

References

Parker M, Johansen A. Hip fracture. BMJ 2006; 333: 27-30.

Maniscalco P, Rivera F, Bertone C, Urgelli S, Bocchi L. Compression hip screw nail-plate system for intertrochanteric fractures. Panminerva Med. 2002. Jun;44(2):135-9. PubMed PMID: 12032432

Frandsen PA, T Kruse T. Hip fractures in the county of Funen, Denmark. Implications of demographic aging and changes in incidence rates. Acta Orthop Scand 1983; 54: 681-6.

Paganini-Hill A, Chao A, Ross RK, Henderson BE. Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 1991; 2: 16-25.

Oldani D, Maniscalco P. Preliminary experience with MEDGAL DHS for treatment of proximal femoral fractures. Acta Biomed 2019; 90: 82-85.

Rebuzzi E, Pannone A, S Schiavetti S, et al. IMHS clinical experience in the treatment of peritrochanteric fractures. The results of a multicentric Italian study of 981 cases. Injury 2002; 33: 407-12.

Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 1984; 186: 45-56.

Muller ME, Nazarian S., Koch P, Schatzker J. The comprehensive classification of fractures of long bones; Springer, Berlin. 1990.

Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand 1980; 51: 803–810

Lee DJ, Elfar JC. Timing of hip fracture surgery in the elderly. Geriatric orthopaedic surgery & rehabilitation 2014; 5: 138–40.

Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 2008; 55: 146-54.

Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One 2012; 7: e46175.

Uzer G, Elmadag NM, Yıldız F, Bilsel K, Erden T, Toprak H. Comparison of two types of proximal femoral hails in the treatment of intertrochanteric femur fractures. Ulus Travma Acil Cerrahi Derg 2015; 21: 385–91.

Makridis KG, Georgaklis V, Georgoussis M, Mandalos V, Kontogeorgakos V, Badras L. Comparing two intramedullary devices for treating trochanteric fractures: A prospective study. J Orthop Surg Res 2010; 5: 9.

Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am 2001;83:643–650.

Hardy DC, Drossos K. Slotted intramedullary hip screw nails reduce proximal mechanical unloading. Clin Orthop Relat Res 2003; 406: 176–84.

Rantanen J, Aro HT. Intramedullary fixation of high subtrochanteric femoral fractures: A study comparing two implant designs, the Gamma nail and the intramedullary hip screw. J Orthop Trauma 1998; 12: 249–52.

Maniscalco P, Caforio M, Imberti D, Porcellini G, Benedetti R. Apixaban versus enoxaparin in elective major orthopedic surgery: a clinical review. Clin Appl Thromb Hemost 2015; 21: 115-9.

Ministero della Salute, CCM. Indagine multicentrica sugli esiti delle fratture degli arti inferiori negli anziani a seguito di incidente domestico, 2007.

Swiatek L, Olejnik A, Grabarczyk J. The influence of the DLC and DLC-Si coatings on the changes occurring on the implants surface during the implant-bone contact. Eng Biomaterials 2016; 19: 2-12.

Koryszewski K, Bociąga D, Skowroński R. Results of peritrochanteric fracture treatment with carbon (DLC) and silicon-carbon (Si-DLC) coated Gamma nail – preliminary report. Chir Narzadow Ruchu Ortop Pol 2015; 80: 171-5.

Olejnik A, Świątek L, Bociąga D. Biological evaluation of modified DLC coatings - a review. World Sci News 2017; 73: 61-71.

Ren DW, Zhao Q, Bendavid A. Anti-bacterial property of Si and F doped diamond-like carbon coatings. Surf Coat Tech 2013; 226: 1-6.

Okpalugo TIT, Ogwu AA, Maguire PD, McLaughlin JAD, Hirst DG. In-vitro blood compatibility of a-C:H:Si and a-C:H thin films. Diam Relat Mater 2004; 13: 1088-92.

Ong SE, Zhang S, Du H, Too HC, Aung KN. Influence of silicon concentration on the haemocompatibility of amorphous carbon. Biomater 2007; 28: 4033-8.

Randeniya LK, Bendavid A, Martin PJ, et al. Incorporation of Si and SiOx into diamond-like carbon films: Impact on surface properties and osteoblast adhesion. Acta Biomater 2009; 5: 1791-7.

Ogwu AA, Okpalugo TI, Ali N, Maguire PD, McLaughlin JA. Endothelial cell growth on silicon modified hydrogenated amorphous carbon thin films. J Biomed Mater Res 2008; 85: 105-13.

Okpalugo TI, McKenna E, Magee AC, McLaughlin J, Brown NM. The MTT assays of bovine retinal pericytes and human microvascular endothelial cells on DLC and Si-DLC-coated TCPS. J Biomed Mater Res A 2004; 71: 201-8.

Okpalugo TI1, Murphy H, Ogwu AA, Abbas G, Ray SC, Maguire PD, McLaughlin J, McCullough RW. Human microvascular endothelial cellular interaction with atomic n-doped DLC compared with Si-doped DLC thin films. J Biomed Mater Res B Appl Biomater 2006; 78: 222-9.

G. Thorwarth, B. Saldamli, Schwarz, F, et al. Biocompatibility of doped diamond-like carbon coatings for medical implants. Plasma Process Polym 2007; 4: 364-8.

Li X, Zhang L, Hou Z, et al. Distal Locked and unlocked nailing for perthrochanteric fractures – A prospective comparative randomized study. Int Orthop 2015; 39: 1645-52.

Ciaffa V, Vicenti G, Mori CM. Unlocked versus dynamic and static distal locked femoral nails in stable and unstable intertrochanteric fractures. A prospective study. Injury 2018; 49: 19-25.

Oldani D, Maniscalco P. Preliminary experience with EBA ONE intramedullary nail for the treatment of pertrochanteric fractures. Acta Biomed 2019; 90: 86-90.

Vishwanathan K, Akbari K, Patel AJ. Is the modified Harris hip score valid and responsive instrument for outcome assessment in the Indian population with pertrochanteric fractures? J Orthop 2018; 15: 40-6.

Downloads

Published

30-05-2020

How to Cite

1.
Maniscalco P, Quattrini F, Ciatti C, Burgio V, Rivera F, Di Stefano G, et al. A preliminary experience with a new intramedullary nail for trochanteric fractures. Acta Biomed [Internet]. 2020 May 30 [cited 2024 Jul. 27];91(4-S):122-7. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/9726