Mustafa YERLİ, Ali Çağrı TEKİN, Mehmet Kürşad BAYRAKTAR, Hakan GÜRBÜZ, Nazım ERKURT, Tahsin Olgun BAYRAKTAR, Ali YÜCE, Müjdat ADAŞ

Clinical and radiological results of cemented proximal femoral nails

Aim: Osteoporotic interthoracanteric fractures are an important health problem affecting the elderly population. Cement augmentation is a modification that has been applied with increasing frequency in recent years. In our study, we aimed to retrospectively analyze the clinical and functional results of proximal femoral nails (PFN) with cemented augmentation. Materials and Methods: Sixty-five patients who met the inclusion criteria were included in the study. PN1 PFNA Nail - Tasarım Medikal ® - İstanbul nails were applied to all patients. Information such as spreading area of cement, closest distance of cement to cartilage, number of additional fluoroscopy for cementing procedure, amount of cement were collected. Reductions were evaluated according to the Modified Baumgaertner Criteria and rehabilitation protocols were applied. Pain of the patients was evaluated with the vas score, and hip functionality with the Harris score. Patients with a minimum follow-up of 2 years were included in the study. Results: The amount of cement placed in the femoral heads of 37 patients with Singh index values of 1 and 2 was found to be 2.9±0.5 ml, significantly higher than the amount of cement placed in the femoral head (2.1±0.3 ml) of patients with Singh index 3, 4, 5 (p < 0.001). After the PFN application, an average of 4.8 ± 2.0 more fluoroscopy was taken for the cementing process. VAS scores were 4.1 ± 2.2, and Modified Harris scores were 75.3 ± 8.5 at the 6th month postoperatively. At the 2nd year postoperatively, the vas scores were 3.5 ± 2.5, while the Modified Harris Scores were 74 ± 10.5. Conclusion: In conclusion, cement-augmented proximal femoral nails appear to be an implant with both good functional results and good quality of life results with early mobilization. But it is clear that both cement and nail design do not solve all the problems in interthoracanteric fractures.

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1. Lorich DG, Geller DS, Nielson JH: Osteoporotic Pertrochanteric Hip Fractures Management And Current Controversıes J Bone Joint Surg 86; 398-410, 2004.
2. Kammerlander C, Gebhard F, Meier C, et al. Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial. Injury. 2011 Dec;42(12):1484-90. doi: 10.1016/j.injury.2011.07.010. Epub 2011 Aug 19. PubMed PMID: 21855063.
3. Erhart S, Schmoelz W, Blauth M, Lenich A. Biomechanical effect of bone cement augmentation on rotational stability and pull-out strength of the Proximal Femur Nail Antirotation™. Injury. 2011 Nov;42(11):1322-7. doi:10.1016/j.injury.2011.04.010. Epub 2011 May 23. PubMed PMID: 21601203.
4. Bonnaire F, Zenker H, Lill C, et al. Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporos Int. 2005 Mar;16 Suppl 2:S93-S102. doi: 10.1007/s00198-004- 1746-7. Epub 2004 Oct 16. PMID 15502962.
5. Von der Linden P, Gisep A, Boner V, et al. Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures. J Orthop Res. 2006 Dec;24(12):2230-7.PubMed PMID: 17001708.
6. Sermon A, Boner V, Schwieger K, et al.Biomechanical evaluation of bone-cement augmented Proximal Femoral Nail Antirotation blades in a polyurethane foam model with low density. ClinBiomech 2012 Jan;27(1):71-6. doi:10.1016/j.clinbiomech.2011.07.006. Epub 2011 Aug 7. PubMed PMID: 21824697.
7. Kammerlander C, Doshi H, Gebhard F, et al. Long-term results of the augmented PFNA: a prospective multicenter trial. Arch Orthop Trauma Surg. 2014 Mar;134(3):343- 9. doi:10.1007/s00402-013-1902-7. Epub 2013 Dec 3. PubMed PMID: 24297215.
8. Fogagnolo F, Kfuri M Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004 Jan;124(1):31- 7. doi: 10.1007/s00402-003-0586-9. Epub 2003 Sep 11. PMID: 13680275.
9. Krischak GD, Augat P, Wachter NJ, Kinzl L, Claes LE. Predictive value of bone mineral density and Singh index for the in vitro mechanical properties of cancellous bone in the femoral head. Clin Biomech 1999 Jun;14(5):346-51. doi: 10.1016/s0268- 0033(98)90095-x. PMID: 10521612.
10. Sermon A, Boner V, Boger A, et al. M. Potential of polymethylmethacrylate cement-augmented helical proximal femoral nail antirotation blades to improve implant stability--a biomechanical investigation in human cadaveric femoral heads. J Trauma Acute Care Surg. 2012 Feb;72(2):E54-9. PubMed PMID: 22439233.
11. Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of peritrochanteric fractures of the hip. J Bone Joint Surg 1995;77-A(7):1058-1064. 62.
12. Caruso G, Bonomo M, Valpiani G, et al. A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: Can the tip-apex distance (TAD) still be considered the best parameter? Bone Joint Res. 2017 Aug;6(8):481-488. doi:10.1302/2046-3758.68.BJR - 2016- 0299. R1PubMedPMID:28790037.
13. Femur Boyun Kırıklarının Tedavisinde Proksimal Femoral Nail Uygulamalarımız R Sevimli, Ö Bilal, Van Tıp Dergisi 20 (4), 207-211
14. Sah AP, Thornhill TS, LeBoff MS, Glowacki J. Correlation of plain radiographic indices of the hip with quantitative bone mineral density. Osteoporos Int. 2007 Aug;18(8):1119-26. Epub 2007 Mar 6. PubMed PMID: 17340218; PubMed Central PMCID: PMC2778043.
15. Singh M, Nagrath AR, Maini PS, Haryana R. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. 1970 J Bone Joint Surg 52A:457–467
16. Sermon A, Hofmann-Fliri L, Richards RG, et al. Cement augmentation of hip implants in osteoporotic bone: how much cement is needed and where should it go? J Orthop Res. 2014 Mar;32(3):362-8. doi: 10.1002/jor.22522. Epub 2013 Nov 20. PubMed PMID: 24259367.
17. Erhart S, Kammerlander C, El-Attal R, Schmoelz W. Is augmentation a possible salvage procedure after lateral migration of the proximal femur nail antirotation? Arch Orthop Trauma Surg. 2012 Nov;132(11):1577-81. doi:10.1007/s00402-012-1579-3. Epub 2012 Jul 3. PubMed PMID: 22752458.
18. Basafa E, Murphy RJ, Kutzer MD, et al. A Particle Model for Prediction of Cement Infiltration of Cancellous Bone in Osteoporotic Bone Augmentation. PLoS One. 2013 Jun 26;8(6):e67958. doi:10.1371/journal.pone.0067958. Print 2013. PubMed PMID: 23840794; PubMed Central PMCID: PMC3693961.