[The Staca nail-plate in the treatment of trochanteric 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 study 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 retrospective 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 post-operative cervical angle, the position of the nail within the femoral neck, the inter-fragmentary distance and the distance 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 general associated pathology. The fracture was always traumatic. The right femur was involved in 97 cases. Following the Ender classification there were 87 stable and 88 unstable fractures (59 complex pertrochanteric, 19 inter and sub-trochanteric and trochantero-diaphyseal).

RESULTS

Post-operative reduction was anatomical in 66 per cent and satisfactory in 89 per cent of cases. In three cases there was an acetabular protrusion of the nail, in two cases there was a varus reduction and fixation and in six cases the plate was not fitting correctly the diaphysis. The average per-operative blood-loss was 300 cc. There was one per-operative death and eight early post-operative deaths. Sitting was allowed 24 hrs, after surgery in 94 per cent of patients. 68 per cent of patients started walking within the first 15 days after surgery. There were 37 per cent general complications, mainly respiratory and urinary infections, but also 2 deep-vein phlebitis, with pulmonary embolism and death. 17 post-operative hematoma were noted, out of which two required surgery. The general mortality reached 15 per cent in three months 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 being able to walk without crutches. Nail acetabular protrusion was observed in 16 cases (3 in early post-operative period, 8 within three months and 2 between the third and the ninth month). The protrusion was related to the nail positioning in 11 out of the 16 cases. This complication required SNP removal in 7 cases, replacement of the SNP in 3 cases and total hip arthroplasty in two cases. Correct nail length assessment 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 comparable results and a stable fixation. The SNP is a reliable implant. The most common complication in our series is protrusion which required reintervention in 6.8 per cent of the cases. Currently we avoid this complication by a good per-operative nail impaction.