Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients
Introduction Intertrochanteric (IT) fractures that fail fixation are traditionally treated with arthroplasty, introducing significant risk of morbidity and mortality in frail older adult patients. Revision fixation with cement augmentation is a relatively novel technique that has been reported in se...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-10-01
|
| Series: | Geriatric Orthopaedic Surgery & Rehabilitation |
| Online Access: | https://doi.org/10.1177/21514593221135480 |
| _version_ | 1811234810894483456 |
|---|---|
| author | Fernando A. Huyke-Hernández BS Arthur J. Only MD Megan Sorich DO Naoko Onizuka MD, PhD Julie A. Switzer MD Brian P. Cunningham MD |
| author_facet | Fernando A. Huyke-Hernández BS Arthur J. Only MD Megan Sorich DO Naoko Onizuka MD, PhD Julie A. Switzer MD Brian P. Cunningham MD |
| author_sort | Fernando A. Huyke-Hernández BS |
| collection | DOAJ |
| description | Introduction Intertrochanteric (IT) fractures that fail fixation are traditionally treated with arthroplasty, introducing significant risk of morbidity and mortality in frail older adult patients. Revision fixation with cement augmentation is a relatively novel technique that has been reported in several small scale international studies. Here we report a clinical series of 22 patients that underwent revision fixation with cement augmentation for IT fracture fixation failure. Methods This retrospective case series identified all patients that underwent revision intramedullary nailing from 2018 to 2021 at two institutions within a large metropolitan healthcare system. Demographics, injury characteristics, Charlson Comorbidity Index score, and surgical characteristics were extracted from the electronic medical record. Outcomes were extracted from the electronic medical record and included radiographic findings, pain, functional outcomes, complications, and mortality. Results Average follow-up after revision surgery was 15.2 ± 10.6 months. Twenty patients (90.9%) reported improved pain and achieved union or progressive healing after surgery. Most of these patients regained some degree of independent ambulation (19 patients, 86.4%), with only 5 patients (22.7%) requiring increased assistance for their activities of daily living (ADLs). One-year mortality was 13.6% (3 patients). Of the 5 patients (22.7%) that experienced complications, 2 patients (9.1%) required revision hemiarthroplasty for subsequent fixation failure. The other 3 patients did well when complications resolved. Conclusions Revision fixation with cement augmentation can be an effective, safe, cost-effective alternative to arthroplasty for the management of cases involving non-infected failed IT fracture fixation with implant cut-out or cut-through limited to the femoral head in older adult patients that have appropriate acetabular bone stock. |
| first_indexed | 2024-04-12T11:41:41Z |
| format | Article |
| id | doaj.art-30da229f2a2d45b0a45f27edda8d5282 |
| institution | Directory Open Access Journal |
| issn | 2151-4593 |
| language | English |
| last_indexed | 2024-04-12T11:41:41Z |
| publishDate | 2022-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Geriatric Orthopaedic Surgery & Rehabilitation |
| spelling | doaj.art-30da229f2a2d45b0a45f27edda8d52822022-12-22T03:34:35ZengSAGE PublishingGeriatric Orthopaedic Surgery & Rehabilitation2151-45932022-10-011310.1177/21514593221135480Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult PatientsFernando A. Huyke-Hernández BSArthur J. Only MDMegan Sorich DONaoko Onizuka MD, PhDJulie A. Switzer MDBrian P. Cunningham MDIntroduction Intertrochanteric (IT) fractures that fail fixation are traditionally treated with arthroplasty, introducing significant risk of morbidity and mortality in frail older adult patients. Revision fixation with cement augmentation is a relatively novel technique that has been reported in several small scale international studies. Here we report a clinical series of 22 patients that underwent revision fixation with cement augmentation for IT fracture fixation failure. Methods This retrospective case series identified all patients that underwent revision intramedullary nailing from 2018 to 2021 at two institutions within a large metropolitan healthcare system. Demographics, injury characteristics, Charlson Comorbidity Index score, and surgical characteristics were extracted from the electronic medical record. Outcomes were extracted from the electronic medical record and included radiographic findings, pain, functional outcomes, complications, and mortality. Results Average follow-up after revision surgery was 15.2 ± 10.6 months. Twenty patients (90.9%) reported improved pain and achieved union or progressive healing after surgery. Most of these patients regained some degree of independent ambulation (19 patients, 86.4%), with only 5 patients (22.7%) requiring increased assistance for their activities of daily living (ADLs). One-year mortality was 13.6% (3 patients). Of the 5 patients (22.7%) that experienced complications, 2 patients (9.1%) required revision hemiarthroplasty for subsequent fixation failure. The other 3 patients did well when complications resolved. Conclusions Revision fixation with cement augmentation can be an effective, safe, cost-effective alternative to arthroplasty for the management of cases involving non-infected failed IT fracture fixation with implant cut-out or cut-through limited to the femoral head in older adult patients that have appropriate acetabular bone stock.https://doi.org/10.1177/21514593221135480 |
| spellingShingle | Fernando A. Huyke-Hernández BS Arthur J. Only MD Megan Sorich DO Naoko Onizuka MD, PhD Julie A. Switzer MD Brian P. Cunningham MD Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients Geriatric Orthopaedic Surgery & Rehabilitation |
| title | Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients |
| title_full | Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients |
| title_fullStr | Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients |
| title_full_unstemmed | Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients |
| title_short | Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients |
| title_sort | outcomes after revision fixation with cement augmentation for failed intertrochanteric fracture fixation in older adult patients |
| url | https://doi.org/10.1177/21514593221135480 |
| work_keys_str_mv | AT fernandoahuykehernandezbs outcomesafterrevisionfixationwithcementaugmentationforfailedintertrochantericfracturefixationinolderadultpatients AT arthurjonlymd outcomesafterrevisionfixationwithcementaugmentationforfailedintertrochantericfracturefixationinolderadultpatients AT megansorichdo outcomesafterrevisionfixationwithcementaugmentationforfailedintertrochantericfracturefixationinolderadultpatients AT naokoonizukamdphd outcomesafterrevisionfixationwithcementaugmentationforfailedintertrochantericfracturefixationinolderadultpatients AT julieaswitzermd outcomesafterrevisionfixationwithcementaugmentationforfailedintertrochantericfracturefixationinolderadultpatients AT brianpcunninghammd outcomesafterrevisionfixationwithcementaugmentationforfailedintertrochantericfracturefixationinolderadultpatients |