Giuseppe Toro1,2, Antimo Moretti1, Daniele Ambrosio3, Raffaele Pezzella4, Annalisa De Cicco1, Giovanni Landi1, Nicola Tammaro1, Pasquale Florio3, Antonio Benedetto Cecere1, Adriano Braile1, Antonio Medici5, Antonio Siano6, Bruno Di Maggio7, Giampiero Calabrò8, Nicola Gagliardo9, Ciro Di Fino10, Gaetano Bruno11, Achille Pellegrino12, Giacomo Negri3, Vincenzo Monaco13, Michele Gison14, Antonio Toro14, Alfredo Schiavone Panni1, Umberto Tarantino2, Giovanni Iolascon1. 1. Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy. 2. Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy. 3. Unit of Orthopaedics and Traumatology, Evangelical Hospital Betania, Naples, Italy. 4. Department of Life Health & Environmental Sciences, University of L'Aquila, Unit of Orthopaedics and Traumatology, L'Aquila, Italy. 5. Unit of Orthopaedics and Traumatology, AORN S. Giuseppe Moscati, Avellino, Italy. 6. Unit of Orthopaedics and Traumatology, Santa Maria Della Speranza Hospital, Battipaglia, Italy. 7. Unit of Orthopaedics and Traumatology, "Ave Gratia Plena" Civil Hospital, Piedimonte Matese, Italy. 8. Unit of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy. 9. Unit of Orthopaedics and Traumatology, San Giuliano Hospital, Giugliano, Italy. 10. Unit of Orthopaedics and Traumatology, AOR San Carlo, Potenza, Italy. 11. Unit of Orthopaedics and Traumatology, AORN Sant'Anna e San Sebastiano, Caserta, Italy. 12. Unit of Orthopaedics and Traumatology, San Giuseppe Moscati Hospital, Aversa, Italy. 13. Unit of Orthopaedics and Traumatology, Santa Maria Incoronata Dell'Olmo Hospital, Cava de' Tirreni, Italy. 14. Unit of Orthopaedics and Traumatology, Villa Malta Hospital, Sarno, Italy.
Abstract
INTRODUCTION: The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients' outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. MATERIALS AND METHODS: A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.
INTRODUCTION: The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients' outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. MATERIALS AND METHODS: A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.
Authors: Lester W M Chan; Antony W Gardner; Merng Koon Wong; Kenon Chua; Ernest B K Kwek Journal: Arch Orthop Trauma Surg Date: 2018-03-12 Impact factor: 3.067
Authors: Conor Kleweno; Jordan Morgan; James Redshaw; Mitchel Harris; Edward Rodriguez; David Zurakowski; Mark Vrahas; Paul Appleton Journal: J Orthop Trauma Date: 2014-07 Impact factor: 2.512