Fractures around Trochanteric Nails: The “Vergilius Classification System”

Abstract

Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients’ outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. Materials and Methods. A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.

Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture

“…In recent years, four different classifications have been proposed for PIFs after intramedullary fixation of proximal femoral fractures [13,[15][16][17]. All classifications take into account the fracture location, whereas some include a description of the PIF morphology and/or initial fracture healing.…”

The treatment of intertrochanteric fracture: a survey on the preferred treatment used by orthopedic surgeons in Campania

“…In contrast to surgeon perception of technical ease, several authors have shown that there is a learning curve associated with CN use 10,12 , and a high risk of complications (including perinail fractures) had been reported. These latter are an emerging entity with specific problems to face, which led some authors to purpose a specific classification system to guide treatment 51 . The most recent Cochrane review on the treatment of pertrochanteric fractures concluded that the SHS may be a superior construct because of a decreased rate of surgical complications compared with CN 6 .…”

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators’ recommendations

“…Some authors hypothesized that a specific algorithm for PIFF could guide trauma surgeons in the difficult decision-making process, but these algorithms can be complex and confusing ( 12 ). Three classification systems have been proposed as an attempt to address the best treatment option ( 13 , 14 , 15 ). Vergilius classification system is focused on fractures around trochanteric nails ( 13 ).…”