[Locking plate fixation of distal periprosthetic femoral fractures : Clinical outcome and mortality]. / Winkelstabile Plattenosteosynthese bei distalen periprothetischen Femurfrakturen : Klinisches Outcome und Mortalität.

BACKGROUND: The care of distal periprosthetic femoral fractures (PFF) is becoming a major interdisciplinary challenge due to demographic developments. The operative treatment is often performed (depending on the type of fracture) by means of locking plate fixation (LPF), although little data on the clinical outcome exist by now. The aim of the study is to identify risk factors for a poor outcome and increased mortality METHODS: In this retrospective study, 36 cases with distal PFF were examined. Exclusively treatment with LPF were included. Relevant previous illnesses (ASA score, Charlson index), fracture morphology and major complications were recorded as well as 1- and 3- year mortality. The clinical outcome was detected by using the Lysholm score. RESULTS: The 1- and 3- year mortality were 9% and 26% - exclusively affecting ASA 3 and 4 patients. The Lysholm Score showed a high variability (65 ± 27 points) with higher values in the ASA 1-2 subgroup (82 vs. 63 points) but independent of fracture type. The preoperative ASA score, the Charlson comorbidity index, and the patient age were determined to be decisive for 3-year mortality. CONCLUSION: This case series displayed a high absolute mortality even if the rate was slightly lower compared to previously published data. The rate of secondary dislocations, lack of fracture healing or follow-up operations were also low. The LPF therefore appears to be a suitable treatment for fractures with a stable prosthesis. However, there is a high variability in the clinical outcome regardless of the type of fracture and significantly increased mortality rates in previously ill patients.

[Minimally invasive treatment of serial metatarsal fractures by antegrade intramedullary K­wire osteosynthesis]. / Minimal-invasive Versorgung von Metatarsale-Serienfrakturen durch antegrade intramedulläre K­Draht-Osteosynthesen.

Serial fractures of metatarsal bones are rare and usually caused by direct or indirect high-energy trauma; however, in cases of pre-existing diseases, such as diabetes mellitus, they also can occur spontaneously or as insidious fractures. Due to the substantial soft tissue swelling mostly associated with such injuries, minimally invasive osteosynthesis with intramedullary Kirschner-wires (K­wires) is recommended. The antegrade technique for placement of the K­wires is preferred as the technically simpler retrograde procedure has several significant disadvantages. The preferred operative approach is described in detail exemplified by two clinical cases.

[Osteoporosis-epidemiology and quality of care]. / Osteoporose ­ Epidemiologie und Versorgungsqualität.

The present review gives a summary of recent epidemiological data on osteoporosis and the state of the quality of care especially regarding older adults. The results show that three quarters of all patients with vertebral and peripheral fractures are older than 65 years. Regarding hip fractures three out of four patients are older than 70 years. The association between age and fractures results as a direct consequence of the practically invariably present underlying osteoporosis and frequent falls in older adults.In Germany the prevalence of osteoporosis among women aged over 50 years is given as 24% and among men as 6%. In contrast to men where the incidence continues to rise, there is a small decrease of the incidence of hip fractures among women. Despite this decrease an enormous increase in both sexes is expected caused by the ongoing demographic changes with substantial socioeconomic consequences.Despite this development, the treatment rates of patients with osteoporosis or fragility fractures have remained low for many years. In contrast, national and international studies have shown that the rate of subsequent fractures could be reduced by up to 50% by using various measures to improve osteoporosis care, such as a fracture liaison service, providing adherence is maintained by the patients.

[Differential diagnoses of osteoporosis]. / Differenzialdiagnosen der Osteoporose.

The differential diagnoses of osteoporosis in geriatric and trauma patients are very important as they may induce different therapies. On average approximately 20% of women and 50% of men have secondary causes of osteoporosis. The foundation of the diagnostics is a basic osteological laboratory investigation with which the most important secondary causes can be identified. From a geriatric and traumatological point of view vitamin D deficiency with secondary hyperparathyroidism, primary hyperparathyroidism, male hypogonadism, multiple myeloma and monoclonal gammopathy of unclear significance (MGUS) are of particular importance.

[Peri-implant femoral fracture following hip arthrodesis in adolescence]. / Periimplantäre Femurfraktur nach Hüftarthrodese im Jugendalter.

This article presents the case of an 83-year-old woman with a peri-implant femoral fracture after hip arthrodesis in adolescence. Due to the rarity of such operations, there is no standardized approach for these cases. In order to secure the treatment goal of rapid pain-adapted full weight bearing despite reduced bone quality, it was decided to perform a new osteosynthesis with a retrograde femoral nail after removal of some fixation screws of the existing arthrodesis plate. Due to this type of treatment, the preservation of activity and independence of an older trauma patient could be sustainably secured despite operative challenges. Taking an extended osteoporosis treatment into consideration, a bony fracture consolidation and complete convalescence of activity and autonomy were ultimately achieved.

[Fractures of the anterior process of the calcaneus-frequently overlooked injuries following ankle sprains]. / Frakturen des Processus anterior calcanei ­ häufig übersehene Verletzungen nach Sprunggelenkdistorsion.

Fractures to the anterior process of the calcaneus (PAC) have long been considered rare injuries and have received little attention in clinical research. On the contrary, recent studies have reported a distinct higher incidence, especially following ankle sprains. Decisive reasons are that fractures of the PAC are regularly missed on plain radiographs and that a clinical differentiation from injuries to the lateral ankle ligaments is difficult. With the broad availability of cross-sectional imaging modalities fractures of the PAC are diagnosed more frequently and more reliably. The purpose of this review is to give an overview on the diagnostics, classification and treatment recommendations to this topic and discuss the studies available. To date no evidence-based recommendations are available for the treatment of fractures of the PAC. The few case reports and case series published, predominantly recommend conservative treatment; however, the treatment regimens vary considerably, ranging from immobilization in a lower leg cast (2-10 weeks) to early functional treatment with full weight-bearing. The surgical treatment by open reduction and internal fixation has been described primarily for large dislocated fractures. Surgical excision is considered mainly in cases of persistent pain or symptomatic non-union following non-operative treatment. For both, non-operative and operative treatment, the case reports and case series report satisfactory outcomes for the majority of patients. Nevertheless, comparative studies and patient-rated outcome measures are missing. Therefore, evidence-based recommendations cannot be given.

[Management of osteoporosis after fragility fractures]. / Management der Osteoporose nach Fragilitätsfrakturen.

Osteoporosis is defined as a systemic bone disease with decreased bone strength and an increased susceptibility for fractures. Older people in particular face an increased risk of fractures. These kind of fractures are usually caused by an inadequate trauma and are the so-called fragility fractures. In older adults immediate fracture stabilization and early mobilization have become the standard procedure after a fragility fracture. Treatment of the underlying osteoporosis often plays a minor role in clinical practice. Only a small group of patients are already under osteoporosis medication and even after a fracture occurs only few patients receive osteoporosis drug treatment with the aim to reduce the progression of osteoporosis and to reduce subsequent fractures. In the literature this has been described as the osteoporosis care gap. The following article presents an overview of treatment options and answers many different questions from the clinical routine.

[Interdisciplinary management in geriatric trauma surgery : Results of a survey in Austria]. / Interdisziplinäres Management in der Alterstraumatologie : Ergebnisse einer österreichweiten Umfrage.

BACKGROUND: The treatment of geriatric patients in the field of trauma surgery is increasingly gaining importance. To provide optimized treatment to these mostly multimorbid patients, interdisciplinary treatment concepts between trauma surgeons and geriatricians have been designed and implemented successfully. OBJECTIVES: The aim of this survey was to evaluate the current state of interdisciplinary management in the treatment of geriatric patients on trauma surgery wards throughout Austria. MATERIAL AND METHODS: The directors of 64 Austrian trauma surgery wards were surveyed using an online-questionnaire regarding the current interdisciplinary treatment of geriatric patients. RESULTS: A total of 39 (61 %) questionnaires were analyzed. Of the participating wards, 20 % distinguished between geriatric and non-geriatric patients. There were various criteria to classify the patients. The average percentage of patients older than 70 years was 43 %. Of the participating wards, 26 % had established a periodical cooperation between trauma surgeons and geriatricians and 8 % of the participants stated that there is no interdisciplinary cooperation. The establishment of an interdisciplinary treatment concept in the near future was planned in 28 %. The most commonly mentioned obstacle that prevented trauma surgery wards from establishing an interdisciplinary management model was the lack of personnel resources (59 %) - especially the lack of geriatricians (62 %). CONCLUSION: The survey's results underline the geriatric trauma surgery's great importance especially regarding the high percentage of geriatric patients, as well as the fact that the significance of the interdisciplinary cooperation between trauma surgeons and geriatricians is not yet perceived by the majority of Austrian trauma surgery wards.

Orthogeriatric co-management improves the outcome of long-term care residents with fragility fractures.

BACKGROUND: Fragility fractures are a major health care problem worldwide. Both hip and non-hip fractures are associated with excess mortality in the years following the fracture. Residents of long-term nursing homes represent a special high-risk group for poor outcomes. Orthogeriatric co-management models of care have shown in multiple studies to have medical as well as economic advantages, but their impact on this high-risk group has not been well studied. OBJECTIVE: We studied the outcome of long-term care residents with hip and non-hip fractures admitted to a geriatric fracture center. METHODS: The study design is a single center, prospective cohort study at a level-I trauma center in Austria running a geriatric fracture center. The cohort included all fragility fracture patients aged over 70 admitted from a long-term care residence from May 2009 to November 2011. The data set consisted of 265 patients; the mean age was 86.8 ± 6.7 years, and 80 % were female. The mean follow-up after the index fracture was 789 days, with a range from 1 to 1842 days. Basic clinical and demographic data were collected at hospital admission. Functional status and mobility were assessed during follow-up at 3, 6, and 12 months. Additional outcome data regarding readmissions for new fractures were obtained from the hospital information database; mortality was crosschecked with the death registry from the governmental institute of epidemiology. RESULTS: 187 (70.6 %) patients died during the follow-up period, with 78 patients (29.4 %) dying in the first year. The mean life expectancy after the index fracture was 527 (±431) days. Differences in mortality rates between hip and non-hip fracture patients were not statistically significant. Compared to reported mortality rates in the literature, hip fracture patients in this orthogeriatric-comanaged cohort had a significantly reduced one-year mortality [OR of 0.57 (95 % CI 0.31-0.85)]. After adjustment for confounders, only older age (OR 1.091; p = 0.013; CI 1.019-1.169) and a lower Parker Mobility Scale (PMS) (OR 0.737; p = 0.022; CI 0.568-0.957) remained as independent predictors. During follow-up, 62 patients (23.4 %) sustained at least one subsequent fracture, and 10 patients (3.4 %) experienced multiple fractures; 29 patients (10.9 %) experienced an additional fracture within the first year. Nearly, half (47.1 %) regained their pre-fracture mobility based on the PMS. CONCLUSION: Despite the generally poor outcomes for fragility fracture patients residing in long-term care facilities, orthogeriatric co-management appears to improve the outcome of high-risk fragility fracture patients. One-year mortality was 29.4 % in this cohort, significantly lower than in comparable trials. Orthogeriatric co-management may also have positive impacts on both functional outcome and the risk of subsequent fractures.

Fast and easy preoperative estimation of cancellous bone mineral density in patients with proximal femur fractures.

INTRODUCTION: Postoperative complications after hip fractures in osteoporotic bone such as implant cutout can be reduced by the use of specially designed implants or additional cement augmentation. It is not yet clear at which degree of osteoporosis, patients will profit from implant augmentation or specially designed implants for geriatric patients. As the surgeon ideally should obtain information on local bone quality at the site of implant anchorage already preoperatively, the aim of the study was to develop an easily applicable radiographic method to estimate bone quality in those patients. MATERIALS AND METHODS: 75 patients with unilateral hip fracture were included. Preoperatively, a CT scan with a calibration device was conducted. Postoperatively, DXA scans were performed. The proposed method measures local cancellous bone mineral density in the contralateral and uninjured femoral head. As a control, 15 young and healthy non-osteoporotic subjects were included. Inter- and intraobserver reliability was investigated for a subgroup of 20 patients. RESULTS: Study group patients had a mean BMD measured by CT scans of 194.2 mg/cm(3) (SD 40.4). There was a statistically significant correlation with data from DXA scans (r = 0.706, p < 0.001). The control group was significantly younger and showed a significantly higher BMD when compared to the study group (p < 0.001). Reliability evaluation showed no statistically significant difference in inter- and intraobserver measurements. Interclass correlation proved to be very high. CONCLUSION: The proposed method is an easily applicable, reliable and useful tool to estimate bone quality preoperatively using the contralateral hip as a reference. Obtained data may facilitate the decision-making towards the use of further therapeutic measures to improve implant anchorage in osteoporotic bone such as bone cement augmentation. Thus, our method allows for a more individualized surgical treatment of hip fracture patients adapted to the estimated cancellous bone quality of the patient.

Urinary incontinence and poor functional status in fragility fracture patients: an underrecognized and underappreciated association.

PURPOSE/INTRODUCTION: Urinary incontinence (UI) affects some 20 % of community-dwelling older people and 30-60 % of people in institutional care. UI is known as an independent predictor of falls, and likely impacts fracture rates. The aim of the study was to measure the prevalence of UI in a typical fragility fracture population, to evaluate the relationship of UI with functional disability in the post-acute setting. METHODS: Our study is a retrospective cross-sectional study of patients admitted to rehabilitation setting after inpatient hospital management for a fragility fracture. We included all consecutively admitted fragility fracture patients aged over 65. All patients underwent standard clinical examination and Geriatric Assessment. We assessed UI using a two-stage process with a six-item UI screening questionnaire followed by an interview. RESULTS: 1,857 (80.7 % female) patients were available for analysis, mean age was 81.7 years. UI was identified in 59.2 % of all fragility fracture patients, and was more prevalent in females. Patients suffering from UI differed significantly in almost all measured functional and cognitive tests, with increased dependency/lower ADL scores, increased rates of immobility, and higher rates of cognitive dysfunction and depression. CONCLUSION: This study confirms the high prevalence of UI in older fragility fracture patients, and the association between UI and functional impairments. The diagnostic work-up and treatment of patients should be focused on the special needs of these older patients. More efforts are needed to increase awareness about prevalence and consequences of UI among older fragility fracture patients.

Fragility non-hip fracture patients are at risk.

INTRODUCTION: Fragility fractures are a growing worldwide health care problem. Hip fractures have been clearly associated with poor outcomes. Fragility fractures of other bones are common reasons for hospital admission and short-term disability, but specific long-term outcome studies of non-hip fragility fractures are rare. The aim of our trial was to evaluate the 1-year outcomes of non-hip fragility fracture patients. METHODS: This study is a retrospective cohort review of 307 consecutive older inpatient non-hip fracture patients. Patient data for analysis included fracture location, comorbidity prevalence, pre-fracture functional status, osteoporosis treatments and sociodemographic characteristics. The main outcomes evaluated were 1-year mortality and post-fracture functional status. RESULTS: As compared to the expected mortality, the observed 1-year mortality was increased in the study group (17.6 vs. 12.2 %, P = 0.005). After logistic regression, three variables remained as independent risk factors for 1-year mortality among non-hip fracture patients: malnutrition (OR 3.3, CI 1.5-7.1), Charlson comorbidity index (CCI) (OR 1.3, CI 1.1-1.5) and the Parker Mobility Score (PMS) (OR 0.85, CI 0.74-0.98). CCI and PMS were independent risk factors for a high grade of dependency after 1 year. Management of osteoporosis did not significantly improve after hospitalization due to a non-hip fragility fracture. CONCLUSION: The outcomes of older non-hip fracture patients are comparable to the poor outcomes of older hip fracture patients, and appear to be primarily related to comorbidities, pre-fracture function and nutritional status. The low rate of patients on osteoporosis medications likely reflects the insufficient recognition of the importance of osteoporosis assessment and treatment in non-hip fracture patients. Increased clinical and academic attention to non-hip fracture patients is needed.

[Co-management in geriatric traumatology]. / Komanagement in der Alterstraumatologie.

BACKGROUND: Fragility fractures are becoming more common and are leading to significantly increased morbidity and mortality rates. METHOD: In order to improve the outcome of these patients, they are increasingly being treated from the beginning interdisciplinarily and interprofessionally as part of co-management models. The main contents of these systems are rapid surgical stabilization for rapid remobilization, treatment with standardized paths and regular communication within the team and a well-functioning discharge management. Furthermore, the organization is a key ingredient in secondary prevention of geriatric traumatology. CONCLUSION: If this system can be implemented as a whole, this will lead to an improvement of the functional outcomes for the patient as well as to cost savings.

[Augmentation techniques on the proximal femur]. / Augmentationstechnik am proximalen Femur.

BACKGROUND: Due to the demographic change fractures of the proximal femur are an increasing major healthcare problem and are associated with the highest mortality among frailty fractures. OBJECTIVES: These mainly osteoporosis-associated fractures of the hip often represent a surgical challenge and the outcome has a decisive influence on the preservation of function and independency of orthogeriatric patients. Augmentation techniques could improve the stability of osteosynthesis in proximal femoral fractures. METHODS: Cement augmentation of proximal femoral nailing (PFNA) for the treatment of pertrochanteric femoral fractures is the most commonly used and standardized method of augmentation for these fractures by which a safer condition for immediate full weight bearing and mobilization can be achieved. RESULTS: In biomechanical and clinical studies good fracture healing was shown and there was no evidence of cement-associated complications in augmented PFNA nailing. In the majority of patients the mobility level prior to trauma could be achieved. CONCLUSION: In addition to the optimal surgical treatment, secondary prevention such as osteoporosis management to avoid further fractures is crucial in the treatment of these patients. This article is based on the current literature and provides an overview of the possible applications of cement augmentation for the treatment of proximal femoral fractures. In addition the surgical approach as well as previous scientific data on an established osteosynthesis using cement-augmented PFNA for the treatment of pertrochanteric frailty fractures are presented.

[New DVO guideline for osteoporosis management 2014 and its importance for trauma surgeons]. / Neue Osteoporose-Leitlinie DVO 2014 und ihre Bedeutung für den Unfallchirurgen.

Osteoporosis-associated fractures represent a growing challenge in the treatment of orthopedic patients. In November 2014 a new revision of the guidelines on osteoporosis by the German Osteology Society (Dachverband Osteologie DVO) was adopted, in which additional risk factors for fractures and further treatment options have been included. On the one hand the existing model used to diagnose osteoporosis and estimate a high fracture risk as a guidance for the use of specific anti-osteoporotic therapy in patients without a fragility fracture was maintained and further refined. On the other hand the guideline includes the option to initiate a specific osteoporosis therapy without a prior bone densitometry in patients with typical radiographs of a proximal femur fracture and higher grade vertebral fractures, suspicious for osteoporosis, depending on the overall clinical context. This may reduce the treatment gap of osteoporosis in Germany. In this paper the changes in the DVO guidelines 2014 on osteoporosis are summarized, focusing on the most important changes with practical relevance for orthopedic surgeons.

[Identification, diagnostics and guideline conform therapy of osteoporosis (DVO) in trauma patients : a treatment algorithm]. / Identifikation, Diagnostik und leitliniengerechte Osteoporosetherapie (DVO) unfallchirurgischer Patienten : Ein Behandlungsalgorithmus.

Osteoporosis-associated fractures are of increasing importance in trauma surgery. The implementation of systematic diagnostics and treatment of osteoporosis during hospitalization, however, remains insufficient; therefore, a specific algorithm for the diagnosis and treatment of osteoporosis in trauma surgery patients was developed based on the German Osteology Society (Dachverband Osteologie, DVO) guidelines for osteoporosis from 2014. In a first step, the individual patient age and risk profile for osteoporosis are identified considering specific fractures indicative of osteoporosis. For these patients a questionnaire is completed which detects specific risk factors. In addition, the physical activity, risk of falls, dietary habits and the individual medication are collated as these can have a decisive influence on the subsequent therapy decisions. Prior to a specific treatment, laboratory osteoporosis tests, bone densitometry by dual energy X-ray absorptiometry (DXA) and if needed X-rays of the spine are carried out. For proximal femoral fractures the treatment of osteoporosis could already be indicated. With pre-existing glucocorticoid therapy, a history of previous fractures or other risk factors according to the risk questionnaire, the threshold of treatment has to be adjusted according to the table of T-scores detected by DXA. The treatment algorithm for diagnostics and treatment of osteoporosis in hospitalized trauma surgery patients can systematically and efficiently improve the identification of patients at risk. Thus, further fractures associated with osteoporosis or failure of internal fixation could be reduced in future. A prospective validation of the algorithm has already be initiated.

[Proximal femoral fractures in the elderly]. / Hüftgelenknahe Femurfrakturen des älteren Menschen.

Proximal femoral fractures represent an increasing major healthcare problem due to the demographic changes in this aging population and are associated with the highest mortality among fractures in elderly patients after suffering insufficiency injuries (so-called fragility fractures). The main aim in the treatment of orthogeriatric patients who suffered from a proximal femoral fracture is the preservation of function and independency. Given the high prevalence of comorbidities in these patients, interdisciplinary and interprofessional approaches are required. The use of modern osteosynthesis procedures can provide an improved, individualized surgical treatment with early full weight bearing of the affected extremity. Another aspect is the accompanying geriatric treatment which is associated with a significant reduction of perioperative and postoperative complications. In addition to acute treatment, the organization of secondary fracture prevention is a crucial pillar of treatment. This article provides an overview of the essential elements of orthogeriatric trauma surgery in elderly patients following proximal femoral fractures.

Inappropriate prescribing as a predictor for long-term mortality after hip fracture.

BACKGROUND: Hip fracture patients are at a higher risk for death compared to age-matched controls. While the reasons for this increased mortality risk are incompletely understood, medical comorbidities and associated medication prescribing likely play an important role in patient outcomes. Altered drug metabolism, polypharmacy and diminished physiologic reserve may all lead to adverse drug reactions and adverse outcomes. Additionally, underprescribing of efficacious medications may deprive older patients of potential therapeutic benefits. OBJECTIVE: The aim of our trial was to estimate the impact of inappropriate medication prescribing on the long-term outcome of older hip fracture patients. METHODS: The present study is a retrospective cohort study. We included all hip fracture patients who were consecutively admitted to our department from 2000 to 2004. We used the previously published STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria to assess the appropriateness of medication prescribing with an additional focus on osteoporosis medications and the total number of prescriptions. Prescriptions meeting STOPP and START criteria were considered 'positive items' and correlated with outcomes. Mortality was assessed by cross-referencing with the national death registry of the Tyrolean Institute of Epidemiology. RESULTS: During the study period, a total of 457 patients with hip fracture (mean age 80.61 ± 7.07 years; range 65-98) were evaluated. The mean number of positive combined STOPP and START items per patient was 2 ± 1.3, with ranges from 0 to 6 (STOPP items), 0 to 4 (START items) and 0 to 7 (combined STOPP/START items). Only 44 (9.6%) of patients had no positive STOPP or START items. The mean number of positive items (STOPP, START and combined) was significantly higher in non-survivors than survivors. The all-cause mortality rate at 3 years was lowest in the subjects with 1 or 0 positive items (20.5%; n = 35) and highest among those with >3 positive items (44.4%; n = 63). Inappropriate medication prescribing remained an independent risk factor with an odds ratio of 1.28 (1.07-1.52) after adjustment for sex, age, activities of daily living, comorbidities and nutrition status. CONCLUSION: Inappropriate medication prescribing is an independent predictor of long-term mortality in older hip fracture patients. It increases the relative risk of mortality in older hip fracture patients by 28%.

Literature review of outcome parameters used in studies of Geriatric Fracture Centers.

INTRODUCTION: A variety of multidisciplinary treatment models have been described to improve outcome after osteoporotic hip fractures. There is a tendency toward better outcomes after implementation of the most sophisticated model with a shared leadership for orthopedic surgeons and geriatricians; the Geriatric Fracture Center. The purpose of this review is to evaluate the use of outcome parameters in published literature on the Geriatric Fracture Center evaluation studies. MATERIALS AND METHODS: A literature search was performed using Medline and the Cochrane Library to identify Geriatric Fracture Center evaluation studies. The outcome parameters used in the included studies were evaluated. RESULTS: A total of 16 outcome parameters were used in 11 studies to evaluate patient outcome in 8 different Geriatric Fracture Centers. Two of these outcome parameters are patient-reported outcome measures and 14 outcome parameters were objective measures. CONCLUSION: In-hospital mortality, length of stay, time to surgery, place of residence and complication rate are the most frequently used outcome parameters. The patient-reported outcomes included activities of daily living and mobility scores. There is a need for generally agreed upon outcome measures to facilitate comparison of different care models.

Long-term results of the augmented PFNA: a prospective multicenter trial.

BACKGROUND: Pertrochanteric fractures are increasing and their operative treatment remains under discussion. Failures needing reoperations such as a cut-out are reported to be high and are associated with multiple factors including poor bone quality, poor fracture reduction and improper implant placement. The PFNA(®) with perforated blade offers an option for standardized cement augmentation with a PMMA cement to provide more stability to the fracture fixation. It remains unclear if the augmentation of this implant does any harm in a longer time span. This prospective multicenter study shows clinical and radiological results with this implant with a mean follow-up time of 15 months. METHODS: In 5 European clinics, 62 patients (79 % female, mean age 85.3 years) suffering from an osteoporotic pertrochanteric fracture (AO 31) were treated with the augmented PFNA(®). The primary objectives were assessment of activities of daily living, pain and mobility. Furthermore, the X-rays were analyzed for the cortical thickness index, changes of the trabecular structure around the cement and the hip joint space. RESULTS: The mean follow-up time was 15.3 months. We observed callus healing in all cases. The surgical complication rate was 3.2 % with no complication related to the cement augmentation. A mean volume of 3.8 ml of cement was injected and no complication was reported due to this procedure. 59.9 % reached their prefracture mobility level until follow-up. The mean hip joint space did not change significantly until follow-up and there were no signs of osteonecrosis in the follow-up X-rays. Furthermore, no blade migration was assessed. CONCLUSION: This study makes us believe that the standardized augmentation of the PFNA with a perforated blade is a safe method to treat pertrochanteric femoral fractures. It leads to good functional results and is not associated with cartilage or bone necrosis.