Preliminary results of the treatment of proximal femoral fractures with the AFFIXUS nail

Contemporary fixation of the proximal femur is performed utilising a number of implants adopting different concepts and techniques. Cephalomedullary nails in particular represent one of two main options, the other being dynamic hip screw (DHS). The aim of this cohort study is to present the early experience of two large units from different countries of the use of the AFFIXUS nail for stabilisation of proximal femoral fractures. Over a period of almost three years, data from 476 proximal femoral fractures were collected and analysed using a specific research protocol, assessing data relevant to basic demographic details, in-hospital stay, surgical technique and post discharge outcomes with a minimum follow up of 6 months. Both the short and long versions of the nail were used in both centres, however, with some statistically significant differences as far as the type of fractures stabilised with the nail, which also translated to differences in the combination or not of 2 lag screws, and the static or dynamic mode of the proximal fixation construct. Other areas of difference amongst the 2 units, were the length of hospital stay and return of patients to their pre-injury residence, most likely reflecting the different social circumstances between the 2 countries. Overall mortality at a median follow up period of 17 months (range 6 to 35) was limited to 6.3%, nonunion and cut out rates 2.7%, whilst revision surgery occurred in just 2.5%. Over the first 6 months of follow up 63.6% returned to their pre-injury ambulatory status and 90.5% to their pre-injury residence. Further studies and higher level of scientific evidence is needed to verify the findings of this retrospective cohort study as to the effectiveness and safety of this new cephalomedullary nail.