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Trochanteric fragility fractures

Treatment using the cement-augmented proximal femoral nail antirotation

Trochantäre Fragilitätsfrakturen

Behandlung mit der zementverstärkten proximalen Femurnagel-Antirotation (PFNA)

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Abstract

Objective

Use of standardized cement augmentation of the proximal femur nail antirotation (PFNA) for the treatment of trochanteric fragility fractures, which are associated with high morbidity and mortality, to achieve safer conditions for immediate full weight-bearing and mobilization, thus, improving preservation of function and independency of orthogeriatric patients.

Indications

Trochanteric fragility fractures (type 31-A1–3).

Contraindications

Ipsilateral arthritis of the hip, leakage of contrast agent into the hip joint, femoral neck fractures.

Surgical technique

Reduction of the fracture on a fracture table if possible, or minimally invasive open reduction of the proximal femur, i. e., using collinear forceps if necessary. Positioning of guidewires for adjustment of the PFNA and the spiral blade, respectively. Exclusion of leakage of contrast agent and subsequent injection of TRAUMACEM™ V+ into the femoral head–neck fragment via a trauma needle kit introduced into the spiral blade. Dynamic or static locking of the PFNA at the diaphyseal level.

Postoperative management

Immediate mobilization of the patients with full weight-bearing and secondary prevention, such as osteoporosis management is necessary to avoid further fractures in the treatment of these patients.

Results

A total of 110 patients older than 65 years underwent the procedure. Of the 72 patients available for follow-up (average age 85.3 years), all fractures healed after an average of 15.3 months. No complications related with cement augmentation were observed. Approximately 60 % of patients achieved the mobility level prior to trauma.

Zusammenfassung

Operationsziel

Verwendung des standardisierten zementverstärkten proximalen Femurnagel-Antirotations(PFNA)-Systems zur Behandlung trochantärer Fragilitätsfrakturen, die mit hoher Morbidität und Mortalität einhergehen, um sicherere Bedingungen für die unmittelbare Vollbelastung und Mobilisierung zu erreichen und damit den Funktionserhalt und die Unabhängigkeit orthogeriatrischer Patienten zu verbessern.

Indikationen

Trochantäre Fragilitätsfrakturen (Typ 31-A1–3)

Kontraindikationen

Ipsilaterale Arthritis des Hüftgelenks, Kontrastmittelaustritt in das Hüftgelenk, Schenkelhalsfrakturen.

Operationstechnik

Reposition der Fraktur möglichst auf einem Repositionstisch oder minimalinvasive offene Reposition des proximalen Femur, z. B. unter Verwendung einer kollinearen Zange, wenn erforderlich. Positionieren von Führungsdrähten zur Ausrichtung des PFNA-Systems bzw. der Spiralklinge. Ausschluss eines Kontrastmittelaustritts und anschließende Injektion von TRAUMACEM™ V+ in das Kopf-Hals-Fragment des Femur über ein Trauma-Nadelsystem, das in die Spiralklinge eingeführt wird. Dynamische oder statische Verriegelung des PFNA-Systems auf Diaphysenebene.

Weiterbehandlung

Unmittelbare Mobilisierung der Patienten mit Vollbelastung und Sekundärprävention, z. B. Osteoporosemanagement, sind notwendig, um weitere Frakturen bei der Behandlung dieser Patienten zu verhindern.

Ergebnisse

Insgesamt wurde das Verfahren bei 110 Patienten mit einem Alter von mehr als 65 Jahren angewendet. Bei den 72 Patienten, die für das Follow-up zur Verfügung standen, (Durchschnittsalter: 85,3 Jahre), heilten alle Frakturen im Durchschnitt nach 15,3 Monaten. Es wurden keine Komplikationen in Zusammenhang mit der Zementverstärkung beobachtet. Annähernd 60 % der Patienten erzielten einen Mobilitätsgrad wie vor dem Trauma.

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Authors and Affiliations

  1. Department of Trauma Surgery, Munich University, Nußbaumstr. 20, 80336, Munich, Germany

    C. Neuerburg, S. Mehaffey, W. Böcker & C. Kammerlander

  2. Department of Trauma Surgery and Sportsmedicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    M. Blauth & C. Kammerlander

  3. Department of Medicine 2/Geriatrics, Paracellsus Medical University, General Hospital Nuremberg, 90419, Nuremberg, Germany

    M. Gosch

Authors
  1. C. Neuerburg
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  2. S. Mehaffey
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Corresponding author

Correspondence to C. Neuerburg.

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Conflict of interest

C. Neuerburg, S. Mehaffey, M. Gosch, W. Böcker, M. Blauth, and C. Kammerlander state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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M. Blauth, Innsbruck

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J. Kühn, Mannheim

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Neuerburg, C., Mehaffey, S., Gosch, M. et al. Trochanteric fragility fractures. Oper Orthop Traumatol 28, 164–176 (2016). https://doi.org/10.1007/s00064-016-0449-5

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