ASSESSMENT OF SURGICAL DECISION-MAKING FOR FRACTURES AROUND TROCHANTERIC NAILS: VERGILIUS CLASSIFICATION SYSTEM VALIDATION

G. Toro¹ , F. Langella² , N. Di Cristofaro¹, A. Moretti³ , G. Conza¹ , Gi. Toro⁴, G. Calabrò⁵ , S. Cerbasi , C. Ruggiero⁶ , G. Martin⁷, R. Carbone⁸, P. Sansone⁹ , F. Urraro¹⁰ , V. Caiaffa , N. Maffulli¹¹ , A. De Sire¹² , M. Manca¹³ , S. Cappabianca¹⁰ , M. Catalano⁸, M. Zappia¹⁴ , M. Berlusconi¹⁵, G. Massazza¹⁶ , G. Gasparini¹² , A. Momoli¹⁷, A. Ammendolia¹² , O. Galasso¹⁸, F. Santolini¹⁹ , R. Pezzella , M. Paoletta³ , G. Iolascon³

¹ Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Napoli, Italy
² IRCCS Galeazzi-Sant'Ambrogio Hospital, Milan, Italy
³ Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
⁴ Unit of Radiology, San Paolo Hospital, Napoli, Italy
⁵ Unit of Orthopaedics and Traumatology, San Francesco d’Assisi Hospital, Oliveto Citra, Italy
⁶ Department of Medicine and Surgery, Division of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
⁷ Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Napoli, Italy
⁸ Unit of Radiology, del Mare Hospital, Naples, Italy
⁹ Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
¹⁰ Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
¹¹ Department of Orthopaedic and Trauma Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital Sapienza University of Rome, Rome, Italy; Centre for Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, UK
¹² Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
¹³ Unit of Orthopedics, USL Northwest-Tuscany, Versilia Hospital, Camaiore, Italy
¹⁴ Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
¹⁵ Humanitas Research Hospital Rozzano, Rozzano, Italy
¹⁶ Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
¹⁷ Unit of Trauma and Orthopaedic, San Bortolo Hospital, Vicenza, Italy
¹⁸ Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
¹⁹ University of Genoa, Genoa, Italy

Correspondence to:

Journal of Orthopedics 2022 Sep-Dec; 14(3): 97-101
https://doi.org/10.69149/orthopedics/2022v14iss3_2

Received: 29 October 2022 Accepted: 3 December 2022

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Abstract

The increasing incidence of fragility fractures, particularly those affecting the proximal femur, has led to a rise in patients with fixation implants and peri-implant fractures. These secondary fractures, occurring around implanted devices such as intramedullary nails, present significant challenges in diagnosis and treatment. A novel classification system, the Vergilius Classification, was developed to provide a structured approach to peri-nail fractures, incorporating fracture location, morphology, fragment count, and healing status of previous fractures. This study aimed to evaluate the agreement among medical professionals in applying this new classification system. A total of 35 medical professionals, including physiatrists, trauma surgeons, and radiologists, participated in the study. They were asked to classify 15 anonymized clinical cases according to the Vergilius system, and their responses were analyzed for accuracy, agreement, and face validity. The results showed a high level of agreement (80%) across most categories, with the location of the fracture, fracture morphology, and number of fracture fragments (2, 3, >3) demonstrating the strongest consensus. However, agreement regarding the healing status of previous fractures was lower. Participants rated the classification as clear, easy to use, and potentially beneficial in clinical practice. This study confirms that the Vergilius Classification System is reliable and applicable for peri-nail fractures. Future real-world cohort studies are needed to further assess its clinical impact.

Keywords: classification, extracapsular, fragility, hip fracture, peri-implant, peri-nail