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.

Abstract

Background: Pertrochanteric fractures are increasing and their operative treatment remains under discussion. Failures needing reoperations such as a cut-out are reported to be high and are associated with multiple factors including poor bone quality, poor fracture reduction and improper implant placement. The PFNA(®) with perforated blade offers an option for standardized cement augmentation with a PMMA cement to provide more stability to the fracture fixation. It remains unclear if the augmentation of this implant does any harm in a longer time span. This prospective multicenter study shows clinical and radiological results with this implant with a mean follow-up time of 15 months.

Methods: In 5 European clinics, 62 patients (79 % female, mean age 85.3 years) suffering from an osteoporotic pertrochanteric fracture (AO 31) were treated with the augmented PFNA(®). The primary objectives were assessment of activities of daily living, pain and mobility. Furthermore, the X-rays were analyzed for the cortical thickness index, changes of the trabecular structure around the cement and the hip joint space.

Results: The mean follow-up time was 15.3 months. We observed callus healing in all cases. The surgical complication rate was 3.2 % with no complication related to the cement augmentation. A mean volume of 3.8 ml of cement was injected and no complication was reported due to this procedure. 59.9 % reached their prefracture mobility level until follow-up. The mean hip joint space did not change significantly until follow-up and there were no signs of osteonecrosis in the follow-up X-rays. Furthermore, no blade migration was assessed.

Conclusion: This study makes us believe that the standardized augmentation of the PFNA with a perforated blade is a safe method to treat pertrochanteric femoral fractures. It leads to good functional results and is not associated with cartilage or bone necrosis.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Cements
  • Bone Nails*
  • Female
  • Femoral Fractures / diagnostic imaging
  • Femoral Fractures / surgery*
  • Femur Head / diagnostic imaging
  • Femur Head / surgery*
  • Follow-Up Studies
  • Fracture Fixation, Intramedullary / adverse effects
  • Fracture Fixation, Intramedullary / instrumentation*
  • Fracture Fixation, Intramedullary / methods*
  • Humans
  • Male
  • Osteoporotic Fractures / diagnostic imaging
  • Osteoporotic Fractures / surgery*
  • Polymethyl Methacrylate
  • Prospective Studies
  • Radiography
  • Reoperation / methods
  • Treatment Outcome

Substances

  • Bone Cements
  • Polymethyl Methacrylate