Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial

Kammerlander, Christian; Gebhard, Florian; Meier, Christoph; Lenich, Andreas; Linhart, W.; Clasbrummel, B.; Neubauer-Gartzke, T.; García-Alonso, Manuel; Pavelka, Tomáš; Blauth, M.

doi:10.1016/j.injury.2011.07.010

Cited by 87 publications

(61 citation statements)

References 46 publications

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“…These devices have been found to suffer from cut-out, implant breakage, femoral shaft fractures, and subsequent loss of reduction in clinical practice (Domingo et al, 2001;Hesse and Gächter, 2004;Andreas Appelt et al, 2007). Kammerlander et al (2011) reported that the standardized cement augmentation using the perforated blade for pertrochanteric fracture fixation enhances the implant anchorage within the head-neck fragment, and leads to good functional results. The PFNA is an intramedullary fixation system, belonging to central fixation, and is advantageous in the treatment of complicated types of osteoporosis fractures compared with the nail-board system.…”

Section: Discussionmentioning

confidence: 99%

Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients

et al. 2014

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ABSTRACT. The cause of postoperative failure after the treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA) was analyzed, and the reoperative methods were examined. Nine failures of 308 femoral intertrochanteric fracture patients with PFNA were treated with femoral prosthesis total hip replacement (THR) and reoperative internal fixation. All nine patients were analyzed to determine the cause of failure. The causes of failed internal fixation in the intertrochanteric-fractured patients included perforation of the helical blade into the hip joint in three cases, cuttingout of the helical blade exit outside in two cases, and hip varus as a result of cutting-out the helical blade in two cases. Seven patients with failed internal fixation were treated with THR. Two patients who had femoral shaft fractures at the end of the nail were treated with longer PFNA. Faulty operative procedures, unsatisfactory reductions, serious osteoporosis, and incorrect positioning of the helical blade were the most important factors responsible for the failed internal fixation. Satisfactory results were achieved with THR and refixation relative to the causes of the failed internal fixation.

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Section: Discussionmentioning

confidence: 99%

Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients

et al. 2014

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“…The PFNA was widely described to be a reliable implant to fix pertrochanteric fractures [18,20,26,35] and the augmented version was previously reported to lead to good short-term functional results [16]. Furthermore, the augmentation of the blade gives the fixation construct much more stability due to a larger bone-implant interface [8-11, 37, 40].…”

Section: Discussionmentioning

confidence: 99%

“…Several biomechanical studies have already proven the mechanical superiority of using a blade instead of a screw in osteoporotic bone [13] and the fixation construct gets even more stable with the use of an additional augmentation with polymethylmethacrylate (PmmA) cement in fact independently of the position of the blade within the head-neck element [8-11, 33, 34]. From the clinical side, the use of an augmented blade is known to lead to good results in short time [16].…”

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confidence: 99%

Long-term results of the augmented PFNA: a prospective multicenter trial

Kammerlander

Doshi

Gebhard

et al. 2013

Arch Orthop Trauma Surg

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MethodsIn 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.

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“…Stabile 31-A1-Frakturen galten bislang als Domäne der DHS, während instabile 31-A2-3-Frakturen zunehmend mit einem intramedullären Verfahren wie dem PFNA versorgt wurden [20]. Dabei konnte in biomechanischen Untersuchungen an osteoporotischen Knochen der mechanische Vorteil der Spiralklinge gegenüber der Schraubenosteosynthese belegt werden, wobei die zusätzliche Augmentation mit Knochenzement die Kontaktfläche des Implantat-/Knochenlagers vergrößert [9].…”

Section: Fraktureinteilung Und Indikationunclassified

“…Dazu wurden bei einem Durchschnittsalter von 85,3 Jahren (49 Frauen/13 Männer) insgesamt 10 A1-Frakturen, 44 A2-und 8 A3-Frakturen, die mit dem zementaugmentierten PFNA versorgt wurden, untersucht. Zum Nachuntersuchungszeitpunkt waren alle Frakturen ohne Nachweis einer Implantatmigration knöchern konsolidiert und es ergaben sich keine Hinweise auf eine Hüft-kopfnekrose oder Osteolyse im Bereich der Zementplombe [20]. Unter Berück-sichtigung verschiedener Funktionstests, wie dem WHO-Performance-und dem Parker-Mobilisations-Status konnte bei 59,5 % der Patienten der Mobilisationsstatus wie vor dem Frakturereignis erreicht werden (.…”

Section: Ergebnisse Mit Dem Zementaugmentierten Pfnaunclassified

Augmentationstechnik am proximalen Femur

Neuerburg

Gosch

Blauth³

et al. 2015

Unfallchirurg

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In addition to the optimal surgical treatment, secondary prevention such as osteoporosis management to avoid further fractures is crucial in the treatment of these patients. This article is based on the current literature and provides an overview of the possible applications of cement augmentation for the treatment of proximal femoral fractures. In addition the surgical approach as well as previous scientific data on an established osteosynthesis using cement-augmented PFNA for the treatment of pertrochanteric frailty fractures are presented.

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Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial

Cited by 87 publications

References 46 publications

Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients

Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients

Long-term results of the augmented PFNA: a prospective multicenter trial

Augmentationstechnik am proximalen Femur

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