Biomechanical Evaluation and Clinical Outcomes of Cement-Augmented PFNA Fixation for Unstable Osteoporotic Intertrochanteric Fractures in the Elderly

Objective To comprehensively evaluate the efficacy of cement-augmented proximal femoral nail antirotation (PFNA) fixation for unstable osteoporotic intertrochanteric fractures through integrated biomechanical testing and clinical analysis. Methods The biomechanical study utilized 8 osteoporotic femur models, randomized into an Augmented Group (PFNA with cement, n = 4) and a Control Group (PFNA only, n = 4). Models underwent progressive static loading (400N, 600N, 800N, 1000N) to measure femoral head migration, followed by a destructive test to determine ultimate load. Clinically, a retrospective review of 20 elderly patients was conducted, comparing the Augmented Group (n = 8) with the Control Group (n = 12) regarding perioperative metrics, rehabilitation, and complications. Results Biomechanically, the Augmented Group demonstrated significantly less femoral head compressive and sliding displacement at all load levels (P < 0.05). Its ultimate load (2411.8 ± 150.4 N) was significantly higher than the Control Group's (2213.6 ± 135.8 N, P < 0.01). Clinically, the Augmented Group had lower early postoperative pain VAS scores (2.5 ± 0.7 vs. 4.2 ± 1.0, P < 0.05), earlier time to partial weight-bearing (2.1 ± 0.6 days vs. 22.8 ± 3.5 days, P < 0.001), and a higher final Harris Hip Score (88.5 ± 5.2 vs. 80.3 ± 6.8, P < 0.05). No cut-out complications occurred in the Augmented Group, compared to 3 (8.3%) in the Control Group. Conclusion Cement augmentation significantly enhances the initial stability and load-bearing capacity of PFNA constructs in osteoporotic bone. This biomechanical advantage translates into superior clinical outcomes, including faster rehabilitation, better functional recovery, and a markedly reduced risk of mechanical failure.