STACA NAIL-PLATE FOR THE TREATMENT OF TRO CHANTERIC FRACTURES

Purpose of the study The Staca nail-plate (SNP) is 32 years old. This implant was created by Descamp and Kerner from Nice in 1964. This stud y evaluates the experience with the SNP in two Orthopaedic Departments from Metz and Nancy Regional Hospitals, between January 1989 and July 1991. Material and methods This is a clinical and radiological retros pective study. Out of the 175 patients, 152 were reviewed at 3 months and 127 at more than 9 months. The radiological assessment was made by measuring the postoperative cervical angle, the position of the nail within the femoral neck, the inter-fragmentary distance and the distan ce between nail and femoral head cartilage. 175 trochanteric fractures (119 women and 56 men) had osteosynthesis with the SNP. The mean age was 79 years (range: 36 to 96 years). Only 29 patients were free of ge neral associated pathology. The fracture was always traumatic. The rig ht femur was involved in 97 cases. Following the Ender classification there were 87 stable and 88 unstable fractures (59 complex pertrochant eric, 19 inter and sub-trochanteric and trochantero-diaphyseal). Resul ts Post-operative reduction was anatomical in 66 per cent and satisfac tory in 89 per cent of cases. In three cases there was an acetabular p rotrusion of the nail, in two cases there was a varus reduction and fi xation and in six cases the plate was not fitting correctly the diaphy sis. The average per-operative blood-loss was 300 cc. There was one pe r-operative death and eight early post-operative deaths. Sitting was a llowed 24 hrs, after surgery in 94 per cent of patients. 68 per cent o f patients started walking withing the first 15 days after surgery. Th ere were 37 per cent general complications, mainly respiratory and uri nary infections, but also 2 deep-vein phlebitis, with pulmonary emboli sm and death. 17 post-operative hematoma were noted, out of which two required surgery. The general mortality reached 15 per cent in three m onths and 22 per cent in nine months. 70 per cent of the patients were free of pain at 3 months and 78 per cent at 9 months, 65 per cent bei ng able to walk without crutches. Nail acetabular protrusion was obser ved in 16 cases (3 in early post-operative period, 8 within three mont hs and 2 between the third and the ninth month). The protrusion was re lated to the nail positioning in 11 out of the 16 cases. This complica tion required SNP removal in 7 cases, replacement of the SNP in 3 case s and total hip arthroplasty in two cases. Correct nail length assessm ent is the important step in order to avoid protrusion and has to take into account the interfragmentary distance after reduction (if any). A good per-operative nail impaction is mandatory. Conclusion Compared to other implants (THS, DHS, Gamma-nail, Ender), the SNP gives compara ble results and a stable fixation. The SNP is a reliable implant. The most common complication in our series is protrusion which required re intervention in 6,8 per cent of the cases. Currently we avoid this com plication by a good per-operative nail impaction.