Outcomes of cement augmentation in fragility trochanteric hip fractures - A multicenter randomized controlled trial follow-up.

PURPOSE: Cement augmentation is considered to improve the bone-implant construct stability in hip fragility fractures, additionally biomechanical studies show that cement augmentation improves the pull-out strength and increases resistance to failure. Thus far, the advantage of these technique used in a clinical scenario is yet to be determined METHODS: a randomized, multicenter, single-blinded clinical trial was conducted in patients aged 65 years or older who were admitted to two level I trauma centers with a fragility intertrochanteric hip fracture during September 2015 and December 2017. Patients were stratified into 2 groups: patients between 65 and 85 years and older than 85 years. A balanced block randomization was performed using blocks of 6 patients: 3 patients assigned to the control group (no augmentation) and 3 patients to the intervention group. Follow-up visits were done at 1, 3, 6 and 12 postoperative months documenting the tip-apex distance (TAD) as well as followed up after 5 to 7 years of surgical procedure documenting EQ5D, Parker Mobility Score and mortality rates at these different time points. RESULTS: A total of 90 patients were included but only 53 patients completed a one-year follow up. The mean immediate postoperative and one-year follow up TAD measurement from the whole cohort (20.99 mm vs 21.3 mm, respectively) showed no statistical significance (P = 0.18). For patients in the control group, the difference of TAD measurements from the immediate postoperative and one-year follow-up was -0.25 mm (P = 0.441). For patients included in the intervention group, the difference of TAD measurement from the immediate postoperative and 1-year follow up was -0.48 mm (P = 0.383). No statistical difference was found when stratified by age (p = 0.78). One patient from the control group had an implant failure after 1-month postoperative. Readmission after 30 days showed no statistical difference between both groups (7 vs. 7 patients, p = 0.754). Augmentation did not show a difference in most of the functional outcomes nor quality of life after 5 to 7 years of surgical procedure. CONCLUSIONS: The use of augmentation can be considered a safe procedure for the fixation of fragility hip fractures.

Fracturas metafisarias distales extraarticulares de tibia: placa percutánea vs. clavo endomedular / Treatment of distal tibial extra-articular metaphysial fractures: plating vs. intramedullary nailing

En el manejo de las fracturas diafisiarias distales de tibia aún existe controversia acerca de cuál técnica quirúrgica ofrece mayores beneficios. El objetivo de este trabajo es describir y comparar las utilizadas, clavo endomedular y placa percutánea, y los resultados en cuanto a consolidación y complicaciones, en pacientes tratados entre enero 2004 y mayo 2008 en el Hospital de San José y una institución asociada de tercer nivel de atención. Se describe una cohorte histórica de 55 pacientes con seguimiento a doce meses. El 76,4% de la población fue de sexo masculino con promedio de edad de 36 años. Se observó mayor porcentaje de mala unión en los pacientes intervenidos con CE (10,7% vs. 7,4%, RR 1.45). La consolidación se presentó en el 92,9% (26/28) de los pacientes manejados con CE contra un 88,9% (24/27) de aquellos con PP. La pseudoartrosis se encontró en dos tratados con CE y en tres con PP (7,1% vs. 11,1%, RR 0.64). La falla del material de osteosíntesis no se observó con el uso de CE, mientras que dos con PP presentaron el evento (0% vs. 7,4%). En cada grupo se vieron dos casos de infección (7,1% vs. 7,4%). Se requirió reintervención en 17,9% (5/28) con CE y en 25,9% (7/27) con PP. El manejo con CE aunque muestra un índice de mala unión mayor que con empleo de PP, evidenciaría un porcentaje de consolidación mayor y unos de complicaciones y reintervención menores. Se requieren estudios futuros multicéntricos para demostrar diferencias entre los dos tipos de tratamientos.

There is still controversy regarding which surgical technique is the most beneficial to manage distal tibial dia- physeal fractures. This paper describes and compares intramedullary nailing and percutaneous plating and results as to consolidation and complications in patients treated between January 2004 and May 2008 at the San José Hospital and at an associate tertiary level health care facility. A 55-patient historical cohort and 12-month follow-up was described. The mean age was 36 years and 76.4% were male patients. A greater incidence of mal-union was observed in those who underwent an intramedullary nailing (10.7 % vs 7.4%, RR 1.45). Consolidation was achieved in 92.9% (26/28) of patients who received nailing compared to 88.9% (24/27) of those managed with plating. Pseudoarthrosis was present in 2 patients treated with a nail fixation and in 3 patients treated with a plate (7.1% vs 11.1%, RR 0.64). Failure of the osteosynthesis material was not observed with the use of nailing while two patients with plating presented this type of event (0% vs 7.4%). Two cases of infection presented in each group (7.1% vs 7.4%). A second surgical intervention was necessary in 17.9% (5/28) of patients with nailing and in 25.9% (7/27) of those in the plating group. Although management with intramedullary nailing shows a greater incidence of mal-union compared to plating, it would evidence a greater percentage of consolidation and less complications and need of a second procedure. Further multicentric trials are required in order to demonstrate the differences between these two treatment modalities.