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Huyke-Hernández FA, Only AJ, Sorich M, Onizuka N, Switzer JA, Cunningham BP. Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients. Geriatr Orthop Surg Rehabil 2022; 13:21514593221135480. [PMID: 36310893 PMCID: PMC9608033 DOI: 10.1177/21514593221135480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Fernando A. Huyke-Hernández
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
| | - Arthur J. Only
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA
| | - Megan Sorich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Naoko Onizuka
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Julie A. Switzer
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Brian P. Cunningham
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA,Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA,Brian P. Cunningham MD, Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, 6500 Excelsior Boulevard, St Louis Park, MN 55426, USA.
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