Outcomes of osteoporotic intertrochanteric fractures treated with cement-augmented proximal femoral nail

Abstract

Background/Aim: Implant failure due to poor bone quality in osteoporotic intertrochanteric fractures increases mortality and morbidity, leading to secondary surgery and complications in patients. Our study aims to evaluate the early functional and radiologic outcomes and complications of osteoporotic intertrochanteric fractures using a cement-augmented proximal femoral nail design. Methods: This case series included 24 patients AO (Arbeitsgemeinschaft für Osteosynthesefragen type 31-A2.2 in 10 patients, A2.3 in 7 patients, 31-A3.1 in 4 patients, and A3.2 in 3 patients). Proximal femoral nail cement augmentation was invariably accomplished by injecting polymethylmethacrylate (PMMA) cement into the femoral head. The clinical outcome was rated using the Harris Hip Score (HSS) at the time of the final follow-up. The results were recorded as excellent (score >90), decent (score 89–70), and poor (score 70–0). Radiographs were reviewed for implant failure and union. Implant failure was defined as lag screw cut-out or perforation. Results: The average age of our sample was 73.8 (6.9) years, And the mean follow-up time was 13.6 months. In all patients, union was accomplished. Implant failure and cut-out were not observed in any of the patients. The average Harris score at the final follow-up was 80.6. According to the HSS, four patients had excellent, 15 had good, and 5 had poor functional results. Conclusion: Cement-augmented femoral nails can be used safely with a low complication rate in osteoporotic intertrochanteric femur fractures. In future studies, controlled studies should be conducted for this nail design.