title: Long-term results of the augmented PFNA: a prospective multicenter trial.
abstract: BACKGROUND
  Pertrochanteric fractures are increasing and their operative treatment remains under discussion. Failures needing reoperations such as a cut-out are reported to be high and are associated with multiple factors including poor bone quality, poor fracture reduction and improper implant placement. The PFNA(®) with perforated blade offers an option for standardized cement augmentation with a PMMA cement to provide more stability to the fracture fixation. It remains unclear if the augmentation of this implant does any harm in a longer time span. This prospective multicenter study shows clinical and radiological results with this implant with a mean follow-up time of 15 months.
  
  
  METHODS
  In 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Trauma Surgery and Sports Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria, christian.kammerlander@i-med.ac.at.
authors.forename: C
authors.initials: C
authors.lastname: Kammerlander
authors.forename: H
authors.initials: H
authors.lastname: Doshi
authors.forename: F
authors.initials: F
authors.lastname: Gebhard
authors.forename: A
authors.initials: A
authors.lastname: Scola
authors.forename: C
authors.initials: C
authors.lastname: Meier
authors.forename: W
authors.initials: W
authors.lastname: Linhart
authors.forename: M
authors.initials: M
authors.lastname: Garcia-Alonso
authors.forename: J
authors.initials: J
authors.lastname: Nistal
authors.forename: M
authors.initials: M
authors.lastname: Blauth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005270:Femur Head / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D019904:Polymethyl Methacrylate; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate