The Carbofix™ "Piccolo Proximal femur nail": A new perspective for treating proximal femur lesion. A technique report

Abstract

Metastases to proximal femur are common and surgery is often suggested to prevent fractures; otherwise it is necessary in cases where this has already occurred. Adjuvant radiotherapy is necessary to reduce the risk of local progression. Nevertheless, the success or failure of radiation therapy treatments depends upon the accuracy in which target identification is correct and dose prescription is fulfilled. Unfortunately, the use of titanium nails consistently limits radiation dose; indeed, the presence of ferromagnetic artifacts interferes with target identification. We present the technique for implant a new carbon fiber nail useful to reduce the ferromagnetic artifacts which allows a better adjuvant radiotherapy.

Keywords: Artifacts; Osteolysis; Pathologic fracture; Proximal femur metastases; Radiotherapy; Tumor.

Fig. 1

Intraoperative X-ray intensifier imaging showing the medullary canal opening (A), the K-wire inserted as guide inside after stylet removal (B), the canal reaming (C) and the nail being inserted inside the canal until the lag-screw marker is in right position (D).

Fig. 2

Intraoperative X-ray intensifier imaging showing the K-wire insertion along the femoral neck (A), the successive reaming (b) and the nail positioned at the right level with the cephalic lag-screw inserted and visible just in the proximal part (C).

Fig. 3

Intraoperative X-ray intensifier imaging showing the AP and LL check to verify the correct insertion of the distal screw; the nail handle is then removed (C).

Fig. 4

AP postoperative X-ray showing the correct placement of the nail.