Comparison of mechanical and clinical outcomes between cement-augmented and conventional cephalomedullary nailing in osteoporotic trochanteric fractures: a propensity score-matched cohort study

Abstract Background Trochanteric fractures in the older population are challenging to treat due to osteoporotic bone and high risk of fixation failure. Cement augmentation (CA) of cephalomedullary fixation has been proposed to enhance implant anchorage and reduce complications. This study compared mechanical failure rates and clinical outcomes between cement-augmented and conventional cephalomedullary nailing in osteoporotic trochanteric fractures. Methods We performed a retrospective comparative study of patients with trochanteric fractures treated with either a CA or non-CA cephalomedullary nail from February 2022 to July 2023. To minimize selection bias, 1:2 propensity score matching was applied to our initial 143 consecutive cases (28 CA, 115 non-CA), yielding 28 augmented and 56 conventional cases. The primary outcome was the rate of implant cut-out. Secondary outcomes were excessive telescopic sliding, 1-year mortality, and patient-reported outcome measures using Harris Hip Score (HHS) and EuroQol 5-Dimension (Eq. 5D) at the final follow up. Results After matching, the CA group had no instances of cut-out (0/28), compared to 1 case (1/56, 1.8%) in the non-CA group (p = 1.00), though the study was underpowered for this rare outcome, with mean follow-up periods of 19.2 ± 18.3 weeks and 23.0 ± 22.5 weeks, respectively. Excessive sliding of the proximal screw occurred in 3 patients (10.7%) with CA versus 7 (12.5%) without (p = 1.00) during the same follow-up period, while 1-year mortality was similar between groups (CA 25.0% vs. non-CA 19.6%, p = 0.78). Final follow-up HHS and Eq. 5D scores were similar between the CA and non-CA groups. No cement-related complications, such as leakage or thermal injury, were observed in this cohort. Conclusions Cement augmentation of a cephalomedullary nail demonstrated comparable mechanical outcomes in terms of cut-out and excessive sliding, as well as similar 1-year mortality and functional outcomes to conventional fixation. This process with a cephalomedullary nail appears to be a safe and effective option for older patients with a trochanteric fracture and shows no postoperative complications. Further large prospective studies are needed to identify patients expected to benefit most from CA. Trial registration not applicable.