F Lavini, L Renzi-Brivio, (Vérone, Italie)
The results of a prospective multi-centre study of Veronail, a new intramedullary implant for trochanteric femoral fractures, are reported. This nail allows the use of two different proximal screw fixation options: parallel sliding or converging fixed locked. In according to AO classification, 111 patients with trochanteric fractures were evaluated in eight Italian hospitals.
The hip function was assessed with the Modified Harris Hip Score. The stable 31.A1 fractures were treated with sliding proximal screws and the subtrochanteric 31.A3 fractures with converging proximal screws. The unstable 31.A2 fractures were treated with both types of proximal fixation.
At one year follow-up there was the same function in patients treated with converging or sliding system. This study suggests a possible new method of treating unstable trochanteric femoral fractures, 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.