Petrochanteric fractures: cement augmentation

Implant augmentation aims to increase the implant to bone surface and to reduce the stresses on the trabecular structures. Augmentation is performed by the injection of small amounts of PMMA through the implant. The additional stability has been shown in biomechanical and clinical studies on Dynamic Hip Screw (DHS) augmentation and on proximal femoral nail augmentation. The decision for augmentation is made after implantation of the helical blade and is based on the clinical judgement of the bone strength of the femoral head during blade insertion by the surgeon. The only contra-indication for proximal femoral nail augmentation is a perforation of the femoral head by the Kirschner-wire or by the helical blade because this would lead to cement leakage in the hip joint. Until now, there is only limited clinical experience. All fractures showed callus formation, no osteonecrosis of the femoral head or lysis around the blade was noticed and no implant migration like cut- out or cut-through was seen. The data suggest that the rate of complications directly related to implant augmentation is very low when the technique is applied correctly.status: publishe