RESEARCH ARTICLE


The PFNA® Augmented in Revision Surgery of Proximal Femur Fractures



Alexander Scola*, Florian Gebhard, Christoph Dehner , Götz Röderer
Ulm University, Department of Orthopaedic Trauma, Ulm, Germany


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Creative Commons License
© Scola et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Ulm University, Department of Orthopaedic Trauma, Albert-Einstein-Allee 23, 89081 Ulm, Germany; Tel: +49 731 50054573; Fax: +49 731 50054502; E-mail: alexander.scola@uniklinik-ulm.de


Abstract

Objectives:

Modern implants for proximal femur fracture treatment have clearly improved clinical results. However, complications, including cut-out and loss of reduction, requiring revision surgery still occur. A major challenge in these cases is a loss of bone stock due to the existing implant, which is usually exacerbated by osteoporosis. A potential solution is the augmentation of implants, for example, of the femoral neck blade using bone cement.

Materials and Methods:

Ten patients (five loosening of femoral neck implant, two pseudarthrosis, two implant failures and one acute fracture) were included. The initial hardware was removed and a PFNA augmented was implanted. The perforated femoral neck blade was augmented using polymethyl methacrylate cement. Clinical and radiological follow-up was performed at a mean of 5.4 months (SD ±4.34). The main outcome parameters were fracture healing and implant-related complications.

Results:

Technical handling was uneventful in all cases. No cement leakage into the joint occurred in any of the cases. The mean amount of cement injected was 5.3 ml. The fracture healed during follow-up in all cases except two patients who died from causes unrelated to the procedure and prior to complete consolidation. Problem-free elective hardware removal of the PFNA augmented was performed in two cases.

Discussion:

The PFNA augmented is a potential implant for joint-preserving revision surgery in proximal femur fractures. The augmentation improves implant anchorage in the impaired bone stock. In this preliminary series, no negative biological side effects of the cement (i.e. osteonecrosis) were observed.

Keywords: Augmentation, cut-out, cut-through, osteoporosis, PFNA, proximal femur fracture..