Cementation: for better or worse? Interim results of a multi-centre cohort study using a fenestrated spiral blade cephalomedullary device for pertrochanteric fractures in the elderly

• Published in: Archives of orthopaedic and trauma surgery 2020-12, Vol.140 (12), p.1957-1964
• Main Authors: Yee, Dennis K. H., Lau, Will, Tiu, Kwok Leung, Leung, Frankie, Fang, Evan, Pineda, Jon Paolo S., Fang, Christian
• Format: Article
• Language: English
• Subjects: Aged; Bone Cements - therapeutic use; Bone Nails; Cement; Cementation - adverse effects; Cementation - instrumentation; Cementation - methods; Cohort analysis; Cohort Studies; Failure; Female; Fracture Fixation, Intramedullary - adverse effects; Fracture Fixation, Intramedullary - instrumentation; Fracture Fixation, Intramedullary - methods; Hip Fractures - surgery; Hong Kong; Humans; Intraoperative Complications - epidemiology; Intraoperative Complications - etiology; Intraoperative Complications - prevention & control; Male; Medicine; Medicine & Public Health; Mortality; Older people; Orthopedics; Outcome and Process Assessment, Health Care; Retrospective Studies; Trauma Surgery
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-020-03449-9

Introduction Cephallomedullary nail fixation is currently the most popular treatment for pertrochanteric fractures. Despite continuous improvement in implant design, fixation failures still occur in a concerning number of cases. This study aims to evaluate the effect of cement augmentation of the new-generation Trochanteric Femoral Nail Advanced (TFNA) perforated spiral blade on complications including fixation failure in the elderly population. Materials and methods We retrospectively evaluated 107 patients aged 65 + treated for pertrochanteric fractures via TFNA between 2015 and 2019 based on whether cementation was used. Baseline demographics, fracture classifications, and reduction quality were compared. Patients with a follow-up of at least 6 months were analyzed for the primary outcome of fixation failure. All patients, regardless of loss to follow-up within 6 months, were analyzed for other complications including mortality. Results Seventy-six patients (47 cemented, 29 non-cemented) had a minimum follow-up of 6 months (mean 13 months). There were no statistically significant differences between the two treatment groups in terms of patient demographics, ASA or AO/OTA fracture classification, reduction quality, or length of follow-up. There was a lower rate of fixation failure in the cement-augmented (CA) group versus the non-cement-augmented (NCA) group (2.1% vs 13.8%; p  = 0.047). No cut-out or cut-through was observed in the CA group. Seven patients had adverse intraoperative events, with a significantly higher rate of fixation failure in these patients (40% vs 2.8%; p  = 0.00). There were no statistically significant differences in 30-day mortality (6.3% CA vs 4.3% NCA; p  = 0.632) or 3-month mortality (9.5% CA vs 12.8% NCA; p  = 0.589). Conclusions Cementation of TFNA blades may decrease risk of fixation failure, however, the surgeon must be aware of potential complications such as cement leakage into the hip joint and be able to manage them as they arise.