Abstract
Purpose: Bone quality in elderly patients always subject to osteoporosis can compromise the stability of osteosynthesis materials. The fixation can be reinforced by using acrylic cement, allowing early rehabilitation. The purpose of the present work was to investigate the quality of acrylic cement-reinforced osteosyntheses and to study the functional consequences of this method. We also analysed early or secondary complications and determined the mid- and long-term advantages and disadvantages for the patient’s quality of life and also for later interventions on the fracture site.
Material and methods: Forty female patients treated between 1990 and 2000 were studied retrospectively. These elderly women (mean age 86.2 years at fracture), had 44 fractures (38 femurs including two with double fractures; four humeri) which had been treated by acrylic cement reinforced ostheosynthesis. The physiological status of the patients before trauma was assessed with the Robinson score and the degree of osteoporosis with the Sinon index. The quality of the cementing was assessed using the Cameron technique. Minimum follow-up was six months, necessary for inclusion.
Results: The preoperative Robinson score was 18.8. The mean Singh index was four. Cementing was satisfactory for 29 fractures. Immediate weight bearing or complete use of the limb was possible early for 42 of the 44 fractures. Bone healing was achieved at a mean 2.8 months for 43 fractures. Mean follow-up was 9.8 months. Twelve patients died before the end of the first postoperative year. At last follow-up, there was one nonunion and five infections, including three bone infections. The Robinson score at last follow-up was 16 on the average. Subsequent interventions did not have to be modified or abandoned because of the acrylic cement reinforcement of the osteosynthesis.
Discussion: The results of this retrospective series are comparable with those obtained with other centromedullary nailing or primary or secondary bone grafting techniques used for the treatment of patients with severe osteoporosis.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
