The role of computer-assisted navigation in intramedullary nailing of pertrochanteric fractures: a prospective multicentre comparative study between EBA II standard and EBA NAV nails

Abstract

Background. Computer-assisted navigation surgery has been gaining increasing importance in several orthopaedic fields in the last decade. However, none of the previous studies has described a navigated system in the intramedullary nailing of pertrochanteric femoral fractures. This prospective comparative study aims to compare, for the first time, a navigated pertrochanteric intramedullary nailing system (EBA NAV) to a traditional cephalo-medullary nail (EBA2). Materials and methods. 100 patients with 31-A1 or 31-A2 pertrochanteric femoral fractures were recruited from January to September 2020. Twenty patients were managed using the EBA-NAV system, whereas 80 patients were treated using a traditional cephalomedullary nail (EBA2) implanted under fluoroscopic guidance. The set-up time of the operating room (ST-OR), surgical time, exposure time to ionising radiation and the dose area product (DAP) were compared in the two groups. Results. Although the ST-OR was longer in patients managed with EBA NAV compared with EBA2 system, shorter surgical time and radiation exposure time was observed during EBA NAV surgery. Furthermore, significant DAP reduction was observed during the EBA NAV procedure. Conclusions. This preliminary study shows that EBA NAV navigated pertrochanteric intramedullary nail allows standardisation of the surgical technique, regardless of the surgeon’s experience, and significantly reduces exposure to ionising radiation, both in terms of time and DAP. EBA NAV could also play a key role in improving the learning curve of residents.