Cement augmentation of the proximal femur nail antirotation: is it safe?

BACKGROUND: Cement augmentation of the proximal femur nail antirotation (PFNA; Fa. DePuy Synthes) showed good biomechanical and clinical results regarding increased stability and functional outcome [Linden et al. in J Orthop Res 24:2230-2237, 2006;Kammerlander et al. in Injury 49:1436-1444, 2018;]. Cement-associated complications are well known in orthopedic procedures like hip arthroplasty, vertebra- and kyphoplasty. This study investigates outcome and safety of augmentation of the proximal femur nail blade. MATERIALS AND METHODS: The retrospective review of the 299 patients (mean age 80 ± 13 years; 205 women and 94 men) focused on perioperative complications after augmentation which was performed with Traumacem V+ Cement (Fa. DePuy Synthes) in 152 cases. The decision for augmentation of the blade was made by the attending surgeon and based on the factors age, bone quality, and fracture pattern. Primary outcome measures were changes in blood pressure, heart rate or oxygen saturation, and the number of needed vasoactive drugs during augmentation. Secondary outcome measures where the rate of cement leakage into the joint, mechanical failure, and perioperative complications like pulmonary embolism, stroke, or heart attack. RESULTS: In 152 augmented cases, no leakage of cement into the joint could be detected. No signs of mechanical failure like cut-out of the blade were seen after 6 weeks and 3 months. Also, augmentation did not show a higher rate of mortality or postoperative complications like stroke, heart attack, embolism, or infection. 57 of 152 augmented cases received an intraoperative intervention with vasoactive medication at the time of augmentation either prophylactically or because of a blood pressure fall. Out of the non-augmented cases, 21 of 147 needed vasoactive medication in the second half of the operation. The difference between these groups was significant (p < 0.05). In the cases without an intervention, there was a significant blood pressure fall of about 8 ± 7.4 mmHg during the augmentation (p < 0.001). Still, none of the augmented cases showed a change in heart rate or oxygen saturation. CONCLUSION: The augmentation of the PFNA blade proved to be a safe procedure. Cement augmentation will not increase postoperative complications or mortality. The risk for leakage of cement into the joint is low and mechanical cut-out might be prevented. The decision for augmentation should be made carefully and always be declared loud and in advance to allow the anesthetist to prepare, because blood pressure changes can occur.

[Investigations on the effect of acupuncture on affective and sensory components of pain in patients with different stages of chronic pain]. / Wirkung der Akupunktur auf die affektivve and sensorische Schmerzbewertung. Untersuchung beipatienten in unterschiedlichen Chronifizierungsstadien]

OBJECTIVES: The aim of the study was to investigate the effects of acupuncture on the affective and sensory experience of pain in chronic pain patients. Furthermore, the study tried to estimate the therapeutical benefit of acupuncture in relation to the stage of chronic pain according to the Mainz pain staging system for chronic pain (MPSS). METHODS: Patients with chronic pain syndromes who received acupuncture treatment answered a standardized pain questionnaire before and after treatment. The questionnaire included the visual-analogue-scale for the intensity of pain, the pain perception scale for the assessment of affective and sensory components of pain perception, and addressed the patients to the three stages of chronic pain (MPSS). RESULTS: From April 1997 to October 1999, patients (n = 165) suffering from chronic headache and facial pain syndromes (23%), spine associated pain syndromes (48%) or other pain conditions (29%) were subsequently included. Treatment with acupuncture showed a more pronounced reduction of the affective assessment than of the sensory assessment of pain. These effects were particularly pronounced in patients assigned to stage 3 of chronic pain (MPSS). CONCLUSIONS: Acupuncture in patients with high-stage chronic pain syndromes preferentially influences the affective dimension of pain perception. For the estimation of the overall clinical outcome of acupuncture treatment, a differentiation between affective and sensory components of pain is recommended.