Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial
Section snippets
Materials and methods
The study was performed at nine orthopaedic departments between October 2009 and July 2010. The inclusion criteria were as follows: pertrochanteric fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, AO/OTA 31A), age 65 years and above, low-energy trauma and signed informed consent. Patients with a pathological fracture, any patients with active malignancy, organ transplantation or infection were excluded. The ethical commission approved the study and every
Results
To investigate the effect of the standardised cement augmentation, 59 patients were analysed. Mean time to follow-up was 4 months (68–355 days). The demographics are shown in Table 1. Associated injuries were noted in two patients. The majority of the patients sustained an unstable pertrochanteric fracture (A2/3; 74.5%). Only 20.3% were independently mobile (Parker Score 9) before their fracture. Mean Parker scores were 4.5 before the fracture and 3.8 at follow-up. At the follow-up, 55.3%
Discussion
The PFNA was proved to be a stable implant for the treatment of proximal femoral fractures.7, 8, 9, 37 Nevertheless, there are complications such as cutting out of the femoral head or blade loosening reported in the literature.7, 8, 9 All these complications are catastrophic failures for these patients due to the necessity of re-operation. As most of these fractures occur in the elderly, these failures are even more severe due to the patients’ co-morbidities and their inability to
Conclusion
The standardised augmentation of the perforated PFNA blade is a safe and user-friendly tool for pertrochanteric fracture fixation. It prevents blade migration within the head–neck fragment and leads to good functional results. These impressions should be proven by a randomised trial comparing the PFNA with and without augmentation.
Conflict of interest
None of the authors has any financial or personal relationship with organisations that could influence their work inappropriately.
Acknowledgements
Synthes is acknowledged for organisational support. There was no involvement of Synthes in study planning, data analysis, interpretation or article writing. The authors would like to thank Dr. Alexander Scola for helping with data management and Dr. Stefanie Erhart for her help with preparation of the article.
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2022, InjuryCitation Excerpt :This procedure, however, exposes these patients to risks during surgery and for postoperative care. Since 2011, polymethylmethacrylate (PMMA) cement augmentation with perforated helical blades for proximal femur fractures has been developed and investigated in cadaveric and clinical studies [3–5]. Cement augmentation showed promising biomechanical and clinical results especially in osteoporotic patients.
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2021, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :All articles used AO/OTA system (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) to include patients in each study: specifically, two studies19,20 treated 31-A1, A2, A3 and three studies30–32 treated 31-A2, A3 fractures. The proximal femoral fractures were reduced and stabilized with Proximal Femur Nail Antirotation (PFNA) (DePuy Synthes, Oberdorf, Switzerland) in 4 studies19,20,30,31 while one study32 Gamma 3 nail (Stryker Trauma GmbH, Schoenkirchen, Germany) using a standard surgical technique. All operations were performed according to standard operating procedures of each femoral nail that provide anatomical reduction of the fracture, guidewire placement and intramedullary nail insertion.
Bone cement augmentation of femoral nail head elements increases their cut-out resistance in poor bone quality– A biomechanical study
2021, Journal of BiomechanicsCitation Excerpt :Therefore, augmentation should be limited to these cases where low bone quality is experienced by the operating surgeon. As stated in previous work on femoral head augmentation, cement leakage into the joint needs to be avoided by following the standard surgical technique including a leakage test prior to cement injection (Kammerlander et al., 2011; Kammerlander et al., 2016). Due to the fracture model used, cement flow in the surrounding bone, followed by backflow at the osteotomy site, was observed in 9 of the 15 augmented cases, thus indicating that existing fracture lines in 50 mm proximity to the femoral head apex could result in PMMA backflow, especially in osteoporotic bone.