Augmented versus non-augmented Trochanteric Fixation Nail-Advanced (TFNA) nails for treating trochanteric fractures in patients over sixty-five years of age.

PURPOSE: Intramedullary nailing is a common treatment for pertrochanteric fractures. However, implant-related mechanical failures, such as cut-out and cut-through, lead to higher rates of revision surgery, loss of autonomy, and mortality. Cemented augmentation enhances the bone-implant interface. This study compared the frequency of mechanical failures between augmented and non-augmented Trochanteric Fixation Nail-Advanced (TFNA) nails. METHODS: This descriptive, retrospective study at a level 1 trauma centre included patients aged > 65 years with pertrochanteric fractures treated by a short augmented or non-augmented TFNA nail. The primary outcome was the comparison of cut-out or cut-through rates between groups at three and six months postoperatively. RESULTS: Of the 181 patients analysed, 103 had augmented TFNA nails and 78 had non-augmented TFNA nails. There were no statistically significant differences between groups in terms of demographic characteristics, AO/OTA classification, or quality of reduction. The failure rate was significantly lower in the augmented group than in the non-augmented group: 1 (0.97%) versus 9 (11.54%) (p = 0.005). At six months postoperatively, there was no significant difference between the two groups concerning functional recovery, as measured by the Parker and EuroQoL 5-Dimensions scores. CONCLUSIONS: For patients aged over 65 years, the use of the augmented TFNA nail may reduce the risk of fixation failures such as cut-out.

Use of a Trochanteric Fixation Nail-Advanced (TFNA) with cement augmentation for treatment of trochanteric fractures in patients greater than sixty five years of age.

PURPOSE: Intramedullary nailing is the standard treatment of trochanteric fractures. Mechanical failure such as cut-out and cut-through are associated with high rates of revision surgery, functional impairment, and mortality. The aim of the study was to evaluate the rate of mechanical failure of the cement augmented screws of Trochanteric Fixation Nail-Advanced (TFNA) nails. PATIENTS AND METHODS: A descriptive, retrospective, multi-operator, single-centre study was performed at our level 1 trauma centre between June 2019 and June 2020. Patients were included if they were > 65 years of age, presented with a trochanteric fracture treated with an augmented TFNA nail with 6 months of follow-up. The primary outcome was fixation failure rate (cut-out or cut-through) at three and six post-operative months. Secondary endpoints were intra-operative data, clinical scores, and radiographic analysis. RESULTS: Forty-five patients (38 women and 7 men) were analysed. The mean age was 82.84 years (65-102, 9.50). There were no instances of mechanical failure in our series, after either three or six months of follow-up. No patient exhibited cut-out or cut-through. The mean amount of cement injected was 4.72 mL (3-6; 1.05). The mean length of surgery was 37.59 min (25-55; 6.48), and the mean intra-operative radiation exposure was 91.47 cGycm2 (25.04-201.81; 51.40) for a mean duration of 43.11 s (17-86; 16.81). The mean duration of hospitalisation was 6.38 days (2-11; 2.27). CONCLUSIONS: Our clinical results suggest that cement-augmented TFNA screws can be successfully used in the management of trochanteric fractures in patients > 65 years of age.

[When should unilateral renal stenosis not be dilated†?] / Quand ne faut-il pas dilater une sténose unilatérale de l'artère rénale†?

Renal artery stenosis can lead to renovascular secondary hypertension. It can also induce an elevation of creatinine, but usually in the case of bilateral stenosis. In addition, it may be associated with the occurrence of heart failure and pulmonary edema. In this context, it may seem intuitive to want to dilate this artery to improve clinical outcome, but the data in current literature speak rather against this intervention. We will see that that there are some specific criteria for revascularization, but the procedure is not without risk. We present here a case of unilateral renal artery stenosis whose indication for invasive treatment was relative, exposing the patients to unnecessary risks.

Une sténose de l'artère rénale peut entraîner une hypertension artérielle secondaire de type rénovasculaire. Elle peut également induire une élévation de la créatinine, mais habituellement en cas de sténose bilatérale. De plus, elle peut être associée à la survenue d'une insuffisance cardiaque, voire d'un œdème aigu du poumon. Dans ce contexte, il peut sembler intuitif de vouloir dilater cette artère afin d'améliorer la situation clinique mais les données de la littérature parlent plutôt contre cette intervention. Nous verrons qu'il existe certains critères précis indiquant une revascularisation, mais que cette procédure n'est pas dénuée de risques. Nous présentons ici le cas d'une sténose de l'artère rénale unilatérale dont l'indication à un traitement invasif était relative, exposant le patient à des risques inutiles.