Proximal Femoral Nail Anti-rotation with Cement Augmentation Reduces the Prevalence of Mechanical Failure for Unstable Type Intertrochanteric fracture in Elderly Patient: A Preliminary Study

Introduction: The incidence of hip fracture in elderly patients has projected to increase world-wide and they were associated with morbidity and mortality. The AAOS 2014 suggested cephalomedullary nail for unstable type of intertrochanteric fracture with a moderate strength of recommendation. However, there was some mechanical failure from Proximal Femoral Nail Anti-rotation (PFNA) blade cut-out in clinical practice after osteoporotic hip fracture fixation. Current literatures lack data demonstrating PFNA with cement augmented blade in clinical study. Therefore, 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. Materials and methods: 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 was done. The primary outcome was measured by the prevalence of PFNA blade cutout. The secondary outcome was time to union, mortality, and functional outcome (HHS). Cement augmented PFNA group was further compared to the standard PFNA (without cement augmentation) in demographic, comorbidities, mechanical failure, mortality, and one year functional outcome. Results: All patients underwent cement augmented PFNA fixation and had no mechanical failure. Additionally, there was comparable rate of mechanical failure between groups (0% vs 3.6%, p=1.000). There was similar time to union (9 vs 9 weeks, p=0.517), mortality rate (10% vs 10.7%, p=1.000) and one-year functional outcome (75.0 vs 75.7, p=0.834) between groups. Conclusion: PFNA with cement augmented blade is safe and this novel technique may be an alternative option for management of unstable type intertrochanteric fracture in elderly patients with discontinuity of principal tensile trabeculae.