Article

The treatment of intertrochanteric fractures of the femur with Endovis nail.

Orthopaedic and Traumatology Department, Santa Maria del Prato Hospital, Feltre, Italy.
Ortopedia, traumatologia, rehabilitacja 12/2011; 13(6):565-72. DOI: 10.5604/15093492.971041
Source: PubMed

ABSTRACT The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly persons with osteoporosis. The imperative goals of treatment are early mobilization by means of stable fixation using as minimally invasive a procedure as possible. Nowadays, there is an increasing interest in intramedullary nailing, especially for unstable intertrochanteric fractures. The aim of the present paper is to assess the efficacy of closed intramedullary osteosynthesis with the Endovis® proximal femoral nail in the treatment of peritrochanteric fractures to solve the problems associated with the use of intramedullary fixation devices.
The authors describe their experience with 87 stable and unstable proximal extra-capsular femoral fractures treated with the Endovis femoral nail from July 2007 to March 2009. The results were evaluated clinically, functionally and radiographically during the 1st, 3th, 6th and 12th months post-op. Pre-injury activity and functional levels were recorded using the modified Harris hip score and V.A.S. score.
Postoperative radiographs showed a near-anatomical fracture reduction in 85% of patients. Three were the cases of cut-out, one case of valgus and two cases of shortening of the operated leg (<1 cm). The Harris Hip Score increased between the thirtieth and ninetieth postoperative day, accompanied by a significant decrease in pain symptoms and functional limitation.
1. The application of an intramedullary nail provides primary stability of the fracture. 2. The Endovis nail constitutes a powerful synthesis for stable and unstable fractures of the trochanteric region, in which is difficult to reconstruct appropriate continuity between the medial and posterior cortical layers. 3.The good mechanical stability of the nail allows rapid mobilization and early functional recovery. 4. The presence of an additional anti-rotational screw and the free sliding mechanism of the lag screw may increase rotational stability of cervico-cephalic fragments and decrease overload on the femoral head.

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    ABSTRACT: Dear Editor, further to the stimulating discussion between the Authors and some readers, we feel that some details about the paper we authored [1] should be clarified. For instance, we called the analyzed system Endovis while the exact name is Endovis Bio Advanced (Endovis BA). Both devices are pertrochanteric intramedullary nails, both are manufactured by Citieffe s.r.l., but Endovis BA represents the evolution of Endovis nail (which has been no more on the market since 2008). The underlying concept design is the same for both nails; in fact, they are both equipped with two parallel cephalic screws and they both allow for distal locking. The two parallel cephalic screws are designed to control and reduce undesired side-effects such as rotational instability and femoral head "cut-off" [2]. Both are available in two different versions (Standard and Medium, Endovis BA is completed by a Long version), and have cervical-diaphyseal angulation to naturally fit the procurved femoral anatomy. Both have a distal diapason profile in order to decrease stiffness difference between the nail and the hosting bone and, consequently, avoid excessive contact stress generation. The main differences between the two systems are represented by [3], [4]: • Material - Endovis BA is made of titanium, whereas Endovis was made of stainless steel. • Cephalic screws - in Endovis BA they have the same diameter, whereas in Endovis they had two different diameters. • Dimensions - Endovis BA is about 15% smaller. Nevertheless, it must be stressed that, with Endovis BA the same key features that proved successful with Endovis were emphasized and improved with the state-of-the-art production technologies and materials. Overall, Endovis BA evolved toward higher patient tolerability while maintaining safety and improving effectiveness [5]. The study we documented in the referred paper [1] was performed using Endovis BA nail (in the period 2007-2009). Hopefully, on the basis of the additional information provided here (which is not anyhow influencing the study's results), perspective readers will be able to adapt the issues faced in the discussion and conclusion sections to Endovis BA rather than to Endovis.
    Ortopedia, traumatologia, rehabilitacja. 10/2013; 15(6):658.

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