Introduction: The incidence of Hip fracture in Elderly patients have projected to increase world-wide (1?2) and they were associated with morbidity and mortality (3?5). There were comparable results between intramedullary device and extramedullary device for stable type-intertrochanteric fracture (6?9) while intramedullary nail was appropriately applied for unstable intertrochanteric fracture (10?11). However, there was some mechanical failure from Proximal Femoral Nail Anti-rotation (PFNA) blade cut-out in clinical practice after osteoporotic hip fracture fixation. A few literatures have identified potential of polymethylmethacrylate cement-augmented helical PFNA blades to improve implant stability only in human cadaveric study (12?13). However, they lack data demonstrating PFNA with cement augmented blade in clinical study.
Objectives: The purpose of our study was to undergo the preliminary study whether PFNA with cement augmented blade reduces the prevalence of mechanical failure for intertrochanteric fracture in elderly patients.
Methodology: After Institutional Research Board Approval, 10 elderly patients with unstable intertrochanteric fractures and Singh index less than grade 4 underwent PFNA with cement augmented blade were done. The primary outcome was measured by the prevalence of PFNA blade cut-out. The secondary outcome was the functional outcome (HHS) and complications including venous thromboembolism (VTE). Functional outcome was categorized into 4 levels: excellent (90?100), good (80?89), fair (70?79), and poor outcome (<70).
Results and Discussion: The average age was 82.5 years old (71?94). None of all patients were assessed as having mechanical failure caused by PFNA blade cut-out and having venous thromboembolism. There was one good functional outcome (10%), eight fair functional outcome (80%), and one poor functional outcome (10%) at one year follow-up while they had one excellent (10%), one good (10%), seven fair (70%), and one poor (10%) functional outcome preoperatively.
Conclusion: PFNA with cement augmented blade is safe and this may be useful for elderly patients with unstable intertrochanteric fracture.
|