INTRACAPSULAR FEMORAL FRACTURES TREATED WITH CORAIL FEMORAL A 10 YEARS SERIES OF 110 PATIENTS

Abstract

A prospective study of displaced femoral neck fractures was conducted, using the Corail® stem, a non cemented HA-coated device, provided with a bipolar head. 293 consecutive patients were included. Our reasons to shift to an uncemented implant were:

1. the existence of intraoperative deaths during cementation;

2. Cardiac failures consecutive to overhydration during cementation (to prevent drop of blood pressure);

3. As life expectancy increases, concerns about skeletal fixation of cemented devices in osteoporotic patients, when the cortico-medullary index decreases.

Follow-up was extended up to 5 years, unless the patient died before. 7 patients were lost from FU. Function was assessed every year using various clinical scores (Parker’s mobility score, Qureshi’s mental status, Jensen’s autonomy index,). An X-Ray was obtained at each visit when possible, with a special insistence at completion of the follow up (136 out of the 144 still alive patients).

Intraoperatively, 11 isolated calcar cracks and 1 fracture of the major trochanter were seen. In three cases, it was impossible to obtain a stable implantation. In two of these, a cemented implant was used. In the third patient, instability was not seen, leading to an 8 mm subsidence, along with thigh pain and distal hypertrophy of the femur. The 278 other patients had no intra-operative complications.

Late complications were:

• 1) 14 patients had a secondary subsidence of their device (1–4 mm), with a subsequent good stability and unaltered fixation to the skeletal tissue;

• 2) No loosening;

• 3) One femoral fracture, due to a second fall (at M4) requiring ORIF;

• 4) 14 small radiolucent line of less than 1 cm in the major trochanter area, whose the meaning remains obscure, as no adverse reactions are seen thereafter;

• 4) no stress shielding, despite a full coating of HA.