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Proximal femoral fractures in the elderly. Does cement augmentation decrease mechanical failures and increase function? A retrospective cohort study
•There was no evidence that augmented proximal femoral nails in the elderly enhances function.•Augmentation does not affect fracture reduction, the positioning of the helical blade, or the tip-apex distance.•Augmentation in proximal femoral fractures appears to be a safe technique, with no increase...
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Published in: | Injury 2024-10, Vol.55, p.111673, Article 111673 |
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Main Authors: | , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites |
Online Access: | Get full text |
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Summary: | •There was no evidence that augmented proximal femoral nails in the elderly enhances function.•Augmentation does not affect fracture reduction, the positioning of the helical blade, or the tip-apex distance.•Augmentation in proximal femoral fractures appears to be a safe technique, with no increase of medical complications.•The present study was unable to demonstrate that augmentation reduces the rate of mechanical failures.
The management of extracapsular proximal femoral fractures (EPFF) with intramedullary nails in the elderly is hindered by osteoporosis, leading to complications that significantly impact functionality due to restrictions for full weight-bearing. We hypothesized that cement augmentation of the cephalic blade could enhance the bone-implant interface and reduce mechanical failure, thereby improving patient functionality in the management of EPFF.
A retrospective cohort study was conducted on patients ≥ 70 years old with type 31-A EPFF (AO/OTA classification) treated with intramedullary nailing between 2017 and 2021, with and without cephalic blade augmentation with bone cement. Evaluation included demographic, clinical/functional parameters, complications, mortality, and radiological assessment (tip-apex distance (TAD), position of the helical blade, cut-out, cut-through, and any fixation failure).
Fifty-eight patients were included, with 30 in the augmented group and 28 in the non-augmented group, with a median age of 88 and 86 years, respectively (p = 0.143), and a median follow-up of 17.9 and 18.2 months, respectively (p = 0.395). Both groups were comparable in terms of sex, Charlson Comorbidity Index, place of residence, pre-fracture mobility, and fracture stability. However, the non-augmented group showed worse ASA grade and pre-fracture cognitive status (p = 0.043). The most common position of the blade was center-center in both groups (96.7 % and 82.1 %, respectively) (p = 0.201). The mean TAD was 15.09 mm (±4.35) in the study group and 16.97 mm (±6.57) in the control group (p = 0.213). At one-year follow-up, there were no differences in medical complications (26.7 % and 28.6 %) (p = 1), surgical complications (6.7 % and 10.7 %) (p = 0.462), mortality (33.3 % and 21.4 %) (p = 0.385), or mechanical failure (0 % and 7.1 %) (p = 0.229). In the augmented group, one patient had intra-articular cement leak and implant infection, and a second patient presented avascular necrosis. In the non-augmented group, there was one periprosthetic fr |
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ISSN: | 0020-1383 1879-0267 1879-0267 |
DOI: | 10.1016/j.injury.2024.111673 |