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. 2021 Jan 12:2021:7532583.
doi: 10.1155/2021/7532583. eCollection 2021.

Fractures around Trochanteric Nails: The "Vergilius Classification System"

Giuseppe Toro  1   2 , Antimo Moretti  1 , Daniele Ambrosio  3 , Raffaele Pezzella  4 , Annalisa De Cicco  1 , Giovanni Landi  1 , Nicola Tammaro  1 , Pasquale Florio  3 , Antonio Benedetto Cecere  1 , Adriano Braile  1 , Antonio Medici  5 , Antonio Siano  6 , Bruno Di Maggio  7 , Giampiero Calabrò  8 , Nicola Gagliardo  9 , Ciro Di Fino  10 , Gaetano Bruno  11 , Achille Pellegrino  12 , Giacomo Negri  3 , Vincenzo Monaco  13 , Michele Gison  14 , Antonio Toro  14 , Alfredo Schiavone Panni  1 , Umberto Tarantino  2 , Giovanni Iolascon  1
Affiliations

Fractures around Trochanteric Nails: The "Vergilius Classification System"

Giuseppe Toro et al. Adv Orthop. .

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.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Summary of the entire procedure done to obtain the consensus for the classification system.
Figure 2
Figure 2
Research strategy.
Figure 3
Figure 3
The main 9 types of PNFs.
Figure 4
Figure 4
A drawing representing a BO2 fracture.
Figure 5
Figure 5
A drawing representing a BO2n fracture.
See this image and copyright information in PMC

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