A newly designed locked intramedullary nail for trochanteric hip fractures fixation: results of the first 100 Trochanteric implantations.

INTRODUCTION: Internal fixation continues to be the surgical treatment of choice for trochanteric region hip fractures. Intramedullary nailing is the updated version of the Küntscher Y nail and provides stable osteosynthesis of trochanteric hip fractures, classically achieved by closed reduction.

MATERIAL AND METHODS: We report on our experience (which started in 2003), using a new fixation device featuring a metaphyseal antegrade nail locked with two cephalic screws and comprising a diaphyseal distal locking. Between April 2003 and September 2006, the first 100 patients who sustained an extracapsular intertrochanteric hip fracture and indicated for internal fixation were prospectively enrolled in this single-center study.

RESULTS: Eighty-six patients (mean age 80.3) were reviewed at 6 months (nine had died, three had failure and two were lost to follow-up) and reported a satisfactory functional outcome (mean Merle d'Aubigné score was 16 and mean Harris Hip score was 90). Union was achieved within a mean delay of 3 months (median 102 days 1/2) in a good anatomical position (mean medialization was 1.86 - ranging from -16 to 0mm, and mean shortening was 1.72 mm - ranging from 0 to 24 mm). Functional recovery was satisfactory with a mean Parker score of 7.52. Total operating time was shortened and good fracture stabilization allowed early weight bearing.

DISCUSSION: Classically, such intertrochanteric fractures can be managed either with a dynamic screw-plate type fixation or with an intramedullary nailing device locked through a single cephalic screw and finally, in rare cases, with a hip arthroplasty supplemented with some sort of fixation. Most published clinical studies of screw-plate fixations have generally reported satisfactory results except for unstable fractures associated with a calcar area lesion. Screw-nail fixations featuring a single cephalic screw should be used in these latter fracture patterns. We believe this new implant design will significantly enhance the anatomical result and functional outcome of these fractures; all this is expected to bring about an earlier recovery of patient's walking ability.

CONCLUSION: This original intramedullary nailing system provides reliable internal fixation means for intertrochanteric fractures since it combines the advantage of a closed reduction procedure with a more stable biomechanical construct.