Abstract
Introduction
In elderly patients, the incidence of a second fracture in the contralateral hip within 2 years of a femoral neck fracture (FNF), ranges from 7 to 12%.
Hypothesis
We want to evaluate the safety and efficacy of the Prevention Nail System (PNS), a titanium screw with a hydroxyapatite-coated thread, developed to prevent contralateral FNFs in severe osteoporotic patients.
Materials and methods
From September 2008 to May 2012, 80 osteoporotic FNF patients (Tscore<;−2.5) were recruited. Patients received standard care for the fractured hip and were randomized to receive either the PNS (Group A), or nothing (Group B) in the contralateral hip. DXA, CT and X-rays of the reinforced hip were scheduled at 3, 12 and 24 months postoperative.
Results
Average follow-up was 26 months. Twenty-one patients reported secondary falls. Group A: 13 patients with 9 osteoporotic fractures (3 contralateral subtrochanteric); Group B: 6 patients with a second osteoporotic fracture (3 contralateral FNF). CT scans showed no radiolucencies or PNS loosenings.
Discussion and Conclusion
In Group A the hip fractures had a spiroid rime beginning from the lateral cortical entry hole; FNFs were fixed with the PNS plate. The secondary fracture occurred, in Group A patients, within a month of hospital discharge; this could be due to the implantation device drill which is wider than the body of the screw. PNS is well tolerated but subtrochanteric fractures may occur in case of difficult insertion of the device.
