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Blade Augmentation in Nailing Proximal Femur Fractures—An Advantage despite Higher Costs?

Background: Proximal femoral fractures occur with increasing incidence, especially in the elderly. Commonly used implants for surgical treatment are cephalomedullary nails. To increase stability, a perforated femoral neck blade can be augmented with cement. The study investigated whether this result...

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Autores principales: Böhringer, Alexander, Cintean, Raffael, Eickhoff, Alexander, Gebhard, Florian, Schütze, Konrad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964020/
https://www.ncbi.nlm.nih.gov/pubmed/36836197
http://dx.doi.org/10.3390/jcm12041661
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author Böhringer, Alexander
Cintean, Raffael
Eickhoff, Alexander
Gebhard, Florian
Schütze, Konrad
author_facet Böhringer, Alexander
Cintean, Raffael
Eickhoff, Alexander
Gebhard, Florian
Schütze, Konrad
author_sort Böhringer, Alexander
collection PubMed
description Background: Proximal femoral fractures occur with increasing incidence, especially in the elderly. Commonly used implants for surgical treatment are cephalomedullary nails. To increase stability, a perforated femoral neck blade can be augmented with cement. The study investigated whether this results in a relevant clinical advantage and justifies the higher cost. Materials and methods: This is a single-center retrospective study of 620 patients with proximal femur fractures treated with cephalomedullary nailing. Between January 2016 and December 2020, 207 male and 413 female patients were surgically treated with a proximal femur nail (DePuy Synthes) using a perforated blade and cement augmentation in cases with severe osteoporosis. Primary outcome measures were the rate of cut-out, tip apex distance and the positioning of the blade in the femoral head. Secondary outcome measures were the implant costs and operating times. Results: Of the 620 femoral neck blades, 299 were augmented with cement. A total of six cut-outs were seen in the first 3 months after the operation. There were three in the cement-augmented group (CAB = cement-augmented blade) and three in the conventional group (NCAB = non-cement-augmented blade). There was a significant positive correlation between age and augmentation, with a mean difference of 11 years between the two groups (CAB 85.7 ± 7.9 vs. NCAB 75.3 ± 15.1; p < 0.05). There was no difference in the tip-apex distance (CAB 15.97 vs. 15.69; p = 0.64) or rate of optimal blade positions between the groups (CAB 81.6% vs. NCAB 83.2%; p = 0.341). Operation times were significantly longer in the cemented group (CAB 62.6 21.2 min vs. NCAB 54.1 7.7 min; p < 0.05), and the implant cost nearly doubled due to augmentation. Conclusion: When the principles of anatomic fracture reduction, optimal tip-apex distance and optimal blade position are combined with cement augmentation in cases of severe osteoporosis, a cut-out rate of less than 1% can be achieved. Nevertheless, it should be noted that augmentation remains expensive and prolongs surgery time without definite proof of mechanical superiority.
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spelling pubmed-99640202023-02-26 Blade Augmentation in Nailing Proximal Femur Fractures—An Advantage despite Higher Costs? Böhringer, Alexander Cintean, Raffael Eickhoff, Alexander Gebhard, Florian Schütze, Konrad J Clin Med Article Background: Proximal femoral fractures occur with increasing incidence, especially in the elderly. Commonly used implants for surgical treatment are cephalomedullary nails. To increase stability, a perforated femoral neck blade can be augmented with cement. The study investigated whether this results in a relevant clinical advantage and justifies the higher cost. Materials and methods: This is a single-center retrospective study of 620 patients with proximal femur fractures treated with cephalomedullary nailing. Between January 2016 and December 2020, 207 male and 413 female patients were surgically treated with a proximal femur nail (DePuy Synthes) using a perforated blade and cement augmentation in cases with severe osteoporosis. Primary outcome measures were the rate of cut-out, tip apex distance and the positioning of the blade in the femoral head. Secondary outcome measures were the implant costs and operating times. Results: Of the 620 femoral neck blades, 299 were augmented with cement. A total of six cut-outs were seen in the first 3 months after the operation. There were three in the cement-augmented group (CAB = cement-augmented blade) and three in the conventional group (NCAB = non-cement-augmented blade). There was a significant positive correlation between age and augmentation, with a mean difference of 11 years between the two groups (CAB 85.7 ± 7.9 vs. NCAB 75.3 ± 15.1; p < 0.05). There was no difference in the tip-apex distance (CAB 15.97 vs. 15.69; p = 0.64) or rate of optimal blade positions between the groups (CAB 81.6% vs. NCAB 83.2%; p = 0.341). Operation times were significantly longer in the cemented group (CAB 62.6 21.2 min vs. NCAB 54.1 7.7 min; p < 0.05), and the implant cost nearly doubled due to augmentation. Conclusion: When the principles of anatomic fracture reduction, optimal tip-apex distance and optimal blade position are combined with cement augmentation in cases of severe osteoporosis, a cut-out rate of less than 1% can be achieved. Nevertheless, it should be noted that augmentation remains expensive and prolongs surgery time without definite proof of mechanical superiority. MDPI 2023-02-19 /pmc/articles/PMC9964020/ /pubmed/36836197 http://dx.doi.org/10.3390/jcm12041661 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Böhringer, Alexander
Cintean, Raffael
Eickhoff, Alexander
Gebhard, Florian
Schütze, Konrad
Blade Augmentation in Nailing Proximal Femur Fractures—An Advantage despite Higher Costs?
title Blade Augmentation in Nailing Proximal Femur Fractures—An Advantage despite Higher Costs?
title_full Blade Augmentation in Nailing Proximal Femur Fractures—An Advantage despite Higher Costs?
title_fullStr Blade Augmentation in Nailing Proximal Femur Fractures—An Advantage despite Higher Costs?
title_full_unstemmed Blade Augmentation in Nailing Proximal Femur Fractures—An Advantage despite Higher Costs?
title_short Blade Augmentation in Nailing Proximal Femur Fractures—An Advantage despite Higher Costs?
title_sort blade augmentation in nailing proximal femur fractures—an advantage despite higher costs?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964020/
https://www.ncbi.nlm.nih.gov/pubmed/36836197
http://dx.doi.org/10.3390/jcm12041661
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