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The ADAPT system is a software that calculate a virtual 3D reconstruction of the femoral head without additional radiation. It automatically detects the used implant and its position relative to the femoral head, helping the surgeon to achieve an optimal proximal screw positioning in the femoral head. The investigators want to verify if with the addition of the ADAPT system the investigators can improve screw placement and reduce surgery time and radiation exposure.
This study is a 2-arm randomized controlled trial comparing intramedullary nailing of proximal fracture of the femur (AO classified as 31 A1.3 , 31 A2.1, 31 A2.2 31 A2.3, 31 A3.1, 31 A3.2, 31 A3.3) performed with the ADAPT system (arm-A) and those performed without (arm-B).
The ADAPT system has been developed with the aim to reduce the rate of complications in intramedullary nailing and its usefulness has been previously explored only in two underpowered randomized controlled trials. Thanks to the possibility to track screw placement in real-time, allowing improved screw placement, the ADAPT system could be a valid tool, in order to minimize radiation exposure, surgical time, and rate of complications.
All the patients undergoing intramedullary nailing at the Ospedale Regionale di Lugano satisfying the eligibility criteria reported at section 7.1 will be enrolled in the study and randomly allocated (allocation ratio 1:1) to receive preoperatively:
The total number of patients enrolled will be 96 (48 arm-A, 48 arm-B). After surgery, data about duration of the procedure, intraoperative blood loss, satisfaction of the surgeon and radiation exposure time will be collected.
Fracture healing, and rate of complications (cut-through and cut out) will be evaluated during all the follow-up visits, alongside VAS and a functional evaluation of the injured hip through the Oxford Hip score.
All treatment related adverse events will be reported up to follow-up visit 4, i.e. up to 12 ± 1 months.
Every patient will be involved in the trial for 1 year. The expected time to complete the trial is 4 years: 3 years for patient enrolment and 1 year to complete the last follow-up
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intramedullary nailing with ADAPT system (arm-A) | Experimental | A commercial product, namely ADAPT will be used as investigation product in arm-A |
|
| Intramedullary nailing without ADAPT system (arm-B) | Active Comparator | No aid in performing intramedullary nailing for proximal femoral fractures will be implemented in arm-B |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intramedullary nailing with ADAPT system | Procedure | Stryker ADAPT®system (ADAPT, Stryker Leibinger GmbH & Co. KG, Freiburg, Germany) is a computer navigation system which can reconstruct a 3D model of the femoral head from the positional information oriented by bidirectional fluoroscopic views. ADAPT shows the distance from the tip of the screw to the surface of the femoral head, tip-to-head-surface distance (TSD), and tip-apex distance (TAD) intraoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| TAD (tip to apex) index at the post-operative X-Ray control prior discharge | The primary outcome of the study is the TAD (tip to apex) index at the post-operative X-Ray control prior discharge. The TAD is the tip-apex distance, which is the sum of the distance from the tip of the lag screw to the apex of the femoral head on an anteroposterior radiograph and this distance on a lateral radiograph, after controlling for magnification. The percentage of cut-outs has been correlated directly to both the severity of proximal femoral fractures and the TAD. | immediately after the surgery |
| Measure | Description | Time Frame |
|---|---|---|
| time of the procedure | time | immediately after the surgery |
| intraoperative blood loss | intraoperative blood loss | during the surgery |
| Measure | Description | Time Frame |
|---|---|---|
| re-fracture rates | re-fracture rates | at 6 weeks, 3 months, 6 months and 1-year |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Christian Candrian, MD | Contact | 0041918117029 | RicercaOrtopedia.ORL@eoc.ch |
| Name | Affiliation | Role |
|---|---|---|
| Christian Candrian, MD | Ente Ospedaliero Cantonale, Bellinzona | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Christian Candrian | Recruiting | Lugano | 6900 | Switzerland |
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| Intramedullary nailing without ADAPT system | Procedure | Intramedullary nailing without ADAPT system |
|
| intraoperative radiation time | intraoperative radiation time | during the surgery |
| surgeon satisfaction on the satisfaction Numerical Rating Scale (NRS scale) | The satisfaction NRS is a self-assessment scale in which surgeons rate their satisfaction on an 11-point numerical scale from 0 (completely dissatisfied) to 10 (completely satisfied). The satisfaction NRS will be administered after surgery | immediately after the surgery |
| non-union | fracture not alligned | at 6 weeks, 3 months, 6 months and 1-year |
| cut-through rate | cut-through rate | at 6 weeks, 3 months, 6 months and 1-year |
| cut-out rate | cut-out rate | at 6 weeks, 3 months, 6 months and 1-year |
| VAS | Visual pain analogue scale, [from 0 (no pain) to 10 (worst pain)] | at 6 weeks, 3 months, 6 months and 1-year |
| Oxford Hip Score, [from 0 (severe hip arthritis) to 48 ( satisfactory joint function)] | Hip function | at 6 weeks, 3 months, 6 months and 1-year |
| ID | Term |
|---|---|
| D005264 | Femoral Fractures |
| ID | Term |
|---|---|
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D007869 | Leg Injuries |
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| ID | Term |
|---|---|
| D005594 | Fracture Fixation, Intramedullary |
| ID | Term |
|---|---|
| D005593 | Fracture Fixation, Internal |
| D005592 | Fracture Fixation |
| D019637 | Orthopedic Procedures |
| D013812 | Therapeutics |
| D013514 | Surgical Procedures, Operative |
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