Cement augmentation of the Proximal Femur Nail Antirotation (PFNA) is associated with enhanced weight-bearing in older adults.
Osteoporosis
cement augmentation
gait analysis
loading rate
mobility
proximal femur fracture
Journal
Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
08
11
2020
revised:
22
01
2021
accepted:
23
01
2021
pubmed:
16
2
2021
medline:
3
11
2021
entrez:
15
2
2021
Statut:
ppublish
Résumé
An early postoperative mobilisation shows beneficial effects in terms of complications and mobilisation scores in older adult proximal femur fracture patients. An adequate load-bearing capacity of the operated extremity is essential for early mobilisation. We hypothesize that cement augmentation of the Proximal Femoral Nail antirotation (PFNA) leads to a higher load capacity during postoperative mobilisation compared to a non-cemented PFNA. Forty-nine orthogeriatric patients with pertrochanteric fractures were enrolled consecutively in a maximum care hospital in a pre-post study design (level of evidence 2). A study group of 25 patients received nailing (PFNA) with additional cement augmentation (CA group), whereas the control group of 24 patients received the same fracture fixation without cement augmentation (NCA Group). All patients participated in a gait analysis using an insole force sensor to measure the loading rate (loadsol®, Novel, Munich, Germany) on the fifth postoperative day. The NCA group showed a mean age of 75,88 years (SD ± 9.62), the CA a mean age of 81,44 years (SD ± 7.77). The most common fracture type was a pertrochanteric fracture in both groups (NCA: n=20, CA: n=21) Both groups showed no differences with regards to the ASA (NCA: 2.67; CA: 2.68) score and the postoperative Parker Mobility Score (NCA: 2.67; CA: 2.68). Patients who received cement augmentation showed a significant (p=0.004) higher loading rate in the postoperative gait analysis. The CA group showed a loading rate of 58.12% (SD ± 14.50) compared to the uncemented PFNA group with 43.90% (SD ± 18.34). Cement augmentation in elderly patients with a proximal femur fracture increased the early postoperative loading rate. Especially in frail patients with poor bone quality cement augmentation should therefore be considered to enhance early mobilisation with full weight bearing in order to reduce complications and improve survival.
Sections du résumé
BACKGROUND
BACKGROUND
An early postoperative mobilisation shows beneficial effects in terms of complications and mobilisation scores in older adult proximal femur fracture patients. An adequate load-bearing capacity of the operated extremity is essential for early mobilisation. We hypothesize that cement augmentation of the Proximal Femoral Nail antirotation (PFNA) leads to a higher load capacity during postoperative mobilisation compared to a non-cemented PFNA.
METHODS
METHODS
Forty-nine orthogeriatric patients with pertrochanteric fractures were enrolled consecutively in a maximum care hospital in a pre-post study design (level of evidence 2). A study group of 25 patients received nailing (PFNA) with additional cement augmentation (CA group), whereas the control group of 24 patients received the same fracture fixation without cement augmentation (NCA Group). All patients participated in a gait analysis using an insole force sensor to measure the loading rate (loadsol®, Novel, Munich, Germany) on the fifth postoperative day.
RESULTS
RESULTS
The NCA group showed a mean age of 75,88 years (SD ± 9.62), the CA a mean age of 81,44 years (SD ± 7.77). The most common fracture type was a pertrochanteric fracture in both groups (NCA: n=20, CA: n=21) Both groups showed no differences with regards to the ASA (NCA: 2.67; CA: 2.68) score and the postoperative Parker Mobility Score (NCA: 2.67; CA: 2.68). Patients who received cement augmentation showed a significant (p=0.004) higher loading rate in the postoperative gait analysis. The CA group showed a loading rate of 58.12% (SD ± 14.50) compared to the uncemented PFNA group with 43.90% (SD ± 18.34).
CONCLUSIONS
CONCLUSIONS
Cement augmentation in elderly patients with a proximal femur fracture increased the early postoperative loading rate. Especially in frail patients with poor bone quality cement augmentation should therefore be considered to enhance early mobilisation with full weight bearing in order to reduce complications and improve survival.
Identifiants
pubmed: 33583593
pii: S0020-1383(21)00075-9
doi: 10.1016/j.injury.2021.01.037
pii:
doi:
Substances chimiques
Bone Cements
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3042-3046Informations de copyright
Copyright © 2021. Published by Elsevier Ltd.