gms | German Medical Science

Objectives: Proximal femur fractures in the elderly population are common and the number of patients is rising. The most common used implants are proximal femur nails and dynamic hip screws. As an advantage, the perforated blade of the proximal femur nail can be augmented with cement to increase the implants stability in the femoral head. This study investigates if there is a benefit for augmentation of the blade of the proximal femur nail in a large cohort of over 600 patients.

Methods: Between January 2014 and December 2020, 207 male and 413 female aged 20-102 (mean 80 years; SD 13) were treated in a level 1 trauma center because of a proximal femur fracture. In all cases a proximal femur nail with a perforated blade was used (PFNA, Fa. DePuy Synthes). The decision for cement augmentation (Traumacem V + Cement, Fa. DePuy Synthes) was made by the attending surgeon based on patients' age, fracture pattern and bone quality. Primary outcome measure were cut out rate, tip apex distance and blade positioning in the femoral head. Secondary outcome measures were length of hospital stay, mortality and non-surgical complications.

Results and conclusion: Out of 620 patients cement augmentation of the blade was performed in 299 cases. The patients in the cement augmented group (CAB) were significantly older (CAB 85.7 +/- 2.9 vs NCAB 75.3 +/- 16.1; p<0,05), had a significantly longer operating time (CAB 62.6h +/- 21,2h vs. NCAB 54.01h +/- 7,1h; p<0.05) and higher hospital mortality (CAB 8.7% vs. NCAB 4.1%; p<0.05). There was no difference between the groups regarding tip apex distance (CAB 15.97 vs. NCAB 15.69; p=0.64) or rate of optimal blade position (CAB 81.6% vs. NCAB 83.2%; p=0.341). Only 6 cut outs were found with 3 patients in each group. There was no difference between the groups for surgical complications (hematoma, infection), non-surgical complications, time to surgery or duration of hospital stay.

In older patients with potential severe osteoporosis augmentation of the blade might have prevented implant failure. More important, if the principles of a tip apex distance less than 25mm and optimal blade position is combined with a modern implant a cut out rate less than 1% is achievable.