Purpose Osteoporotic fractures of the distal femur are an underestimated and increasing problem in trauma and orthopaedic surgery. Therefore, this study investigates the biomechanical potential of implant augmentation in the treatment of these fractures. Methods Twelve osteoporotic surrogate distal femora were randomly assigned to the augmented or non-augmented group. All specimens were fixed using the LCP DF. In the augmented group additionally 1 ml Vertecem V+ was injected in each screw hole before screw positioning. The construct represents an AO 33 A3 fracture. Biomechanical testing was performed as sinusoidal axial loading between 50 and 500 N with 2 Hz for 45,000 cycles, followed by loading between 50 and 750 N until failure. Results The augmented group showed significant higher axial stiffness (36%). Additionally the displacement after 45,000 cycles was 3.4 times lower for the augmented group (0.68 ± 0.2 mm vs. 2.28 ± 0.2 mm). Failure occurred after 45,130 cycles (SD 99) in all of the non-augmented specimens and in two specimens of the augmented group after 69,675 cycles (SD 1729). Four of the augmented specimens showed no failure. The failure mode of all specimens in both groups was a medial cut-out. Conclusions This study shows a promising potential of implant augmentation in the treatment of osteoporotic distal femur fractures.

The potential of implant augmentation in the treatment of osteoporotic distal femur fractures: A biomechanical study

BACKGROUND:Previous studies have clearly demonstrated superior biomechanical behavior of augmented proximal femoral nail antirotation (PFNA) blades compared with nonaugmented ones with respect to implant cutout. Nevertheless, there is concern about thermal bone necrosis due to exothermic curing of p

Ex vivo evaluation of the polymerization temperatures during cement augmentation of proximal femoral nail antirotation blades.

Implant augmentation: adding bone cement to improve the treatment of osteoporotic distal femur fractures: a biomechanical study using human cadaver bones.

Cephallomedullary nail fixation is currently the most popular treatment for pertrochanteric fractures. Despite continuous improvement in implant design, fixation failures still occur in a concerning number of cases. This study aims to evaluate the effect of cement augmentation of the new-generation Trochanteric Femoral Nail Advanced (TFNA) perforated spiral blade on complications including fixation failure in the elderly population. We retrospectively evaluated 107 patients aged 65 + treated for pertrochanteric fractures via TFNA between 2015 and 2019 based on whether cementation was used. Baseline demographics, fracture classifications, and reduction quality were compared. Patients with a follow-up of at least 6 months were analyzed for the primary outcome of fixation failure. All patients, regardless of loss to follow-up within 6 months, were analyzed for other complications including mortality. Seventy-six patients (47 cemented, 29 non-cemented) had a minimum follow-up of 6 months (mean 13 months). There were no statistically significant differences between the two treatment groups in terms of patient demographics, ASA or AO/OTA fracture classification, reduction quality, or length of follow-up. There was a lower rate of fixation failure in the cement-augmented (CA) group versus the non-cement-augmented (NCA) group (2.1% vs 13.8%; p = 0.047). No cut-out or cut-through was observed in the CA group. Seven patients had adverse intraoperative events, with a significantly higher rate of fixation failure in these patients (40% vs 2.8%; p = 0.00). There were no statistically significant differences in 30-day mortality (6.3% CA vs 4.3% NCA; p = 0.632) or 3-month mortality (9.5% CA vs 12.8% NCA; p = 0.589). Cementation of TFNA blades may decrease risk of fixation failure, however, the surgeon must be aware of potential complications such as cement leakage into the hip joint and be able to manage them as they arise.

Cementation: for better or worse? Interim results of a multi-centre cohort study using a fenestrated spiral blade cephalomedullary device for pertrochanteric fractures in the elderly.

The augmentation of fixation with bone cement
is increasingly being used in the treatment of severe osteoporotic fractures.
We investigated the influence of bone quality on the mechanics of
augmentation of plate fixation in a distal femoral fracture model
(AO 33 A3 type). Eight osteoporotic and eight non-osteoporotic femoral
models were randomly assigned to either an augmented or a non-augmented
group. Fixation was performed using a locking compression plate.
In the augmented group additionally 1 ml of bone cement was injected
into the screw hole before insertion of the screw. Biomechanical
testing was performed in axial sinusoidal loading. Augmentation significantly
reduced the cut-out distance in the osteoporotic models by about
67% (non-augmented mean 0.30 mm (sd 0.08) vs augmented
0.13 mm (sd 0.06); p = 0.017). There was no statistical
reduction in this distance following augmentation in the non-osteoporotic
models (non-augmented mean 0.15 mm (sd 0.02) vs augmented
0.15 mm (sd 0.07); p = 0.915). In the osteoporotic models,
augmentation significantly increased stability (p = 0.017). Cite this article: Bone Joint J 2013;95-B:1406–9.

A laboratory investigation to assess the influence of cement augmentation of screw and plate fixation in a simulation of distal femoral fracture of osteoporotic and non-osteoporotic bone

Biomechanical evaluation of bone-cement augmented Proximal Femoral Nail Antirotation blades in a polyurethane foam model with low density

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Biomechanical evaluation of bone-cement augmented Proximal Femoral Nail Antirotation blades in a polyurethane foam model with low density