Pertrochanteric fractures are a rising major health-care problem in the elderly and their operative
stabilisation techniques are still under discussion. Furthermore, complications like cut-out are reported
to be high and implant failure often is associated with poor bone quality. The PFNA1 with perforated
blade offers a possibility for standardised cement augmentation using a polymethylmethacrylate
(PMMA) cement which is injected through the perforated blade to enlarge the load-bearing surface and
to diminish the stresses on the trabecular bone. The current prospective multicentre study was
undertaken to evaluate the technical performance and the early clinical results of this new device.
In nine European clinics, 59 patients (45 female, mean age 84.5 years) suffering from an osteoporotic
pertrochanteric fracture (Arbeitsgemeinschaft fu¨ r Osteosynthesefragen, AO-31) were treated with the
augmented PFNA1. Primary objectives were assessment of operative and postoperative complications,
whereas activities of daily living, pain, mobility and radiologic parameters, such as cement distribution
around the blade and the cortical thickness index, were secondary objectives.
The mean follow-up time was 4 months where we observed callus healing in all cases. The surgical
complication rate was 3.4% with no complication related to the cement augmentation. More than onehalf
of the patients reached their prefracture mobility level within the study period. A mean volume of
4.2 ml of cement was injected. We did not find any cut-out, cut through, unexpected blade migration,
implant loosening or implant breakage within the study period.
Our findings lead us to conclude that the standardised cement augmentation using the perforated
blade for pertrochanteric fracture fixation enhances the implant anchorage within the head–neck
fragment and leads to good functional results.
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