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Cementation: for better or worse? Interim results of a multi-centre cohort study using a fenestrated spiral blade cephalomedullary device for pertrochanteric fractures in the elderly

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Cephallomedullary nail fixation is currently the most popular treatment for pertrochanteric fractures. Despite continuous improvement in implant design, fixation failures still occur in a concerning number of cases. This study aims to evaluate the effect of cement augmentation of the new-generation Trochanteric Femoral Nail Advanced (TFNA) perforated spiral blade on complications including fixation failure in the elderly population.

Materials and methods

We retrospectively evaluated 107 patients aged 65 + treated for pertrochanteric fractures via TFNA between 2015 and 2019 based on whether cementation was used. Baseline demographics, fracture classifications, and reduction quality were compared. Patients with a follow-up of at least 6 months were analyzed for the primary outcome of fixation failure. All patients, regardless of loss to follow-up within 6 months, were analyzed for other complications including mortality.

Results

Seventy-six patients (47 cemented, 29 non-cemented) had a minimum follow-up of 6 months (mean 13 months). There were no statistically significant differences between the two treatment groups in terms of patient demographics, ASA or AO/OTA fracture classification, reduction quality, or length of follow-up. There was a lower rate of fixation failure in the cement-augmented (CA) group versus the non-cement-augmented (NCA) group (2.1% vs 13.8%; p = 0.047). No cut-out or cut-through was observed in the CA group. Seven patients had adverse intraoperative events, with a significantly higher rate of fixation failure in these patients (40% vs 2.8%; p = 0.00). There were no statistically significant differences in 30-day mortality (6.3% CA vs 4.3% NCA; p = 0.632) or 3-month mortality (9.5% CA vs 12.8% NCA; p = 0.589).

Conclusions

Cementation of TFNA blades may decrease risk of fixation failure, however, the surgeon must be aware of potential complications such as cement leakage into the hip joint and be able to manage them as they arise.

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Availability of data

The data that support this study are available from the Hong Kong Hospital Authority Clinical Data and Reporting System (CDARS), but restrictions apply to these data, which were used under license for the current study, and so are not publicly available.

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Acknowledgements

The authors wish to acknowledge Yip Siu On for assisting with radiographic measurement.

Funding

This study was not supported by any research funding.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China

    Dennis K. H. Yee, Will Lau, Frankie Leung, Evan Fang & Christian Fang

  2. Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, China

    Kwok Leung Tiu

  3. East Avenue Medical Center, East Avenue, Diliman, Metro Manila, 1100, Quezon City, Philippines

    Jon Paolo S. Pineda

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Correspondence to Dennis K. H. Yee.

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Ethical approval is not required for secondary data according to regional guidelines as set out by the Hospital Authority Head Office Steering Committee on Research Ethics (https://www.med.hku.hk/images/document/04research/institution/ha-investigator-cop.pdf).

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Yee, D.K.H., Lau, W., Tiu, K.L. et al. Cementation: for better or worse? Interim results of a multi-centre cohort study using a fenestrated spiral blade cephalomedullary device for pertrochanteric fractures in the elderly. Arch Orthop Trauma Surg 140, 1957–1964 (2020). https://doi.org/10.1007/s00402-020-03449-9

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