Injury. 2025 Dec 3;57(2):112923. doi: 10.1016/j.injury.2025.112923. Online ahead of print.
ABSTRACT
INTRODUCTION: Cement augmentation has the potential to reduce the high failure rates commonly associated with internal fixation in patients with unstable femoral trochanteric fractures. Although current treatment guidelines for femoral trochanteric fractures are comprehensive, most have not mentioned cement augmentation fixation as a treatment option. The objective of this study is to formulate expert consensus statements on the use of cephalomedullary nails with cement augmentation for managing femoral trochanteric fractures in Japan.
METHODS: A modified Delphi approach, comprising two rounds of anonymous surveys and one Expert Meeting, was used to establish consensus on the use of cement augmentation in unstable femoral trochanteric fractures among 15 orthopaedic surgeons (3 Steering Committee members, 12 Expert Panellists) from Japan who have insights into using cement augmentation. Expert Panellists indicated their agreement with each statement on a 5-point Likert scale. Consensus was defined as ≥75 % of Expert Panellists selecting either "Agree"/"Strongly Agree" or "Disagree"/"Strongly Disagree".
RESULTS: Consensus was reached for 53 % of statements (18/34) in Round 1 and 85 % of statements (11/13) in Round 2. Ultimately, 29 statements reached consensus, of which 10 statements were on "Patient Selection" (primary cases, age, bone density, surgery, revision cases and pre-operative assessments for cement augmentation), 9 were on "Surgical Approaches", 6 were on "Post-Operative Care and Rehabilitation" and 4 were on "Expected Functional Outcomes". There were 2 statements that did not reach consensus.
CONCLUSIONS: Japanese orthopaedic surgeons were largely aligned on patient selection, surgical approaches, post-operative care, rehabilitation, and expected outcomes of cement-augmented cephalomedullary nail fixation for femoral trochanteric fractures. When monitored, this technique lowers the potential risk of cement leakage and may also reduce complications, reoperation rates, and postoperative pain, while improving functional outcomes, indicating a favourable safety profile. This consensus serves as an important reference for orthopaedic surgeons in Japan and beyond, particularly given the growing concern over these fractures in Japan's ageing population and that of the wider region. However, consensus was not reached on some aspects due to the limited availability of Japan-specific evidence. Further studies on efficacy and safety outcomes, particularly among the Japanese population, are needed to establish best practices.
PMID:41453239 | DOI:10.1016/j.injury.2025.112923