Short proximal femoral nail with cement augmentation: concept, technique, and literature review

Background: Trochanteric fractures in patients over 65 years of age frequently result from low-energy trauma and osteoporosis. While short intramedullary nailing is the standard treatment, poor bone-implant interface quality in osteoporotic bone can lead to mechanical failures such as cut-out or cut-through, necessitating revision surgery and increasing patient morbidity.

Objective: This article describes the technical application, biomechanical rationale, and clinical evidence for polymethylmethacrylate (PMMA) cement augmentation of cervico-cephalic screws in trochanteric nails.

Key Points: Cement augmentation involves injecting PMMA through cannulated, perforated implants to enhance the bone-implant interface. Technical success requires precise guide wire placement, ideally at least 1 cm from the joint, to prevent intra-articular leakage. The procedure utilizes specific injection kits with graduated cannulas and syringes to deliver 3 to 6 mL of cement. Biomechanical studies indicate that augmentation significantly increases rotational stability and pull-out strength compared to non-augmented constructs. Clinical data demonstrate a reduction in serious mechanical complications, with some series reporting 0% revision rates for augmented nails compared to 4.4%–13.8% in non-augmented cohorts. Furthermore, the technique serves as a potential salvage option for migrating implants.

Conclusion: Cemented augmentation of trochanteric nails is a reproducible technique that improves primary stability in osteoporotic bone. By reducing the incidence of mechanical failure, it facilitates early mobilization and helps preserve autonomy in the elderly population.