L Henry Goodnough1, Harsh Wadhwa2, Seth S Tigchelaar2, Malcolm R DeBaun2, Michael J Chen2, Matt L Graves3, Michael J Gardner2. 1. Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, 450 Broadway St., Pavilion C, 4th Floor, Redwood, CA, 94063, USA. lhenrygoodnough@gmail.com. 2. Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, 450 Broadway St., Pavilion C, 4th Floor, Redwood, CA, 94063, USA. 3. Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
Abstract
INTRODUCTION: Achieving durable mechanical stability in geriatric intertrochanteric proximal femur fractures remains a challenge. Concomitant poor bone quality, unstable fracture patterns, and suboptimal reduction are additional risk factors for early mechanical failure. Cement augmentation of the proximal locking screw or blade is one proposed method to augment implant anchorage. The purpose of this review is to describe the biomechanical and clinical evidence for cement augmentation of geriatric intertrochanteric fractures, and to elaborate indications for cement augmentation. METHODS: The PubMed database was searched for English language studies up to January 2021. Studies that assessed effect of calcium phosphate or methylmethacrylate cement augmentation during open reduction and internal fixation of intertrochanteric fractures were included. Studies with sample size < 5, nontraumatic or periprosthetic fractures, and nonunion or revision surgery were excluded. Study selection adhered to PRISMA criteria. RESULTS: 801 studies were identified, of which 40 met study criteria. 9 studies assessed effect of cement augmentation on fracture displacement. All but one found that cement decreased fracture displacement. 10 studies assessed effect of cement augmentation on total load or cycles to failure. All but one demonstrated that augmented implants increased this variable. Complication rates of cement augmentation during ORIF of intertrochanteric fractures ranged from 0 to 47%, while non-augmented implants ranged from 0 to 51%. Reoperation rates ranged from 0 to 11% in the cement-augmented group and 0 to 11% in the non-augmented group. Fixation failure ranged from 0 to 11% in the cement-augmented group and 0 to 20% in the non-augmented group. Nonunion ranged from 0 to 3.6% in the cement-augmented group and 0 to 34% in the non-augmented group. CONCLUSIONS: Calcium phosphate or PMMA-augmented CMN fixation of IT fractures increased construct stability and improved outcomes in biomechanical and early clinical studies. The findings of these studies suggest an important role for cement augmentation in patient populations at high risk of mechanical failure.
INTRODUCTION: Achieving durable mechanical stability in geriatric intertrochanteric proximal femur fractures remains a challenge. Concomitant poor bone quality, unstable fracture patterns, and suboptimal reduction are additional risk factors for early mechanical failure. Cement augmentation of the proximal locking screw or blade is one proposed method to augment implant anchorage. The purpose of this review is to describe the biomechanical and clinical evidence for cement augmentation of geriatric intertrochanteric fractures, and to elaborate indications for cement augmentation. METHODS: The PubMed database was searched for English language studies up to January 2021. Studies that assessed effect of calcium phosphate or methylmethacrylate cement augmentation during open reduction and internal fixation of intertrochanteric fractures were included. Studies with sample size < 5, nontraumatic or periprosthetic fractures, and nonunion or revision surgery were excluded. Study selection adhered to PRISMA criteria. RESULTS: 801 studies were identified, of which 40 met study criteria. 9 studies assessed effect of cement augmentation on fracture displacement. All but one found that cement decreased fracture displacement. 10 studies assessed effect of cement augmentation on total load or cycles to failure. All but one demonstrated that augmented implants increased this variable. Complication rates of cement augmentation during ORIF of intertrochanteric fractures ranged from 0 to 47%, while non-augmented implants ranged from 0 to 51%. Reoperation rates ranged from 0 to 11% in the cement-augmented group and 0 to 11% in the non-augmented group. Fixation failure ranged from 0 to 11% in the cement-augmented group and 0 to 20% in the non-augmented group. Nonunion ranged from 0 to 3.6% in the cement-augmented group and 0 to 34% in the non-augmented group. CONCLUSIONS: Calcium phosphate or PMMA-augmented CMN fixation of IT fractures increased construct stability and improved outcomes in biomechanical and early clinical studies. The findings of these studies suggest an important role for cement augmentation in patient populations at high risk of mechanical failure.
Authors: Joshua A Parry; Motasem Salameh; Michael H Maher; Stephen C Stacey; Cyril Mauffrey Journal: J Orthop Trauma Date: 2020-11 Impact factor: 2.512
Authors: Lorraine C Stern; John T Gorczyca; Stephen Kates; John Ketz; Gillian Soles; Catherine A Humphrey Journal: J Orthop Trauma Date: 2017-06 Impact factor: 2.512
Authors: David J Ciufo; Douglas A Zaruta; Jason S Lipof; Kyle T Judd; John T Gorczyca; John P Ketz Journal: J Orthop Trauma Date: 2017-11 Impact factor: 2.512
Authors: Deepak Bushan Raina; Vetra Markevičiūtė; Mindaugas Stravinskas; Joeri Kok; Ida Jacobson; Yang Liu; Erdem Aras Sezgin; Hanna Isaksson; Stefan Zwingenberger; Magnus Tägil; Šarūnas Tarasevičius; Lars Lidgren Journal: Front Bioeng Biotechnol Date: 2022-03-02
Authors: Erdem Aras Sezgin; Ahmet Toygun Tor; Vėtra Markevičiūtė; Aurimas Širka; Šarūnas Tarasevičius; Deepak Bushan Raina; Yang Liu; Hanna Isaksson; Magnus Tägil; Lars Lidgren Journal: Jt Dis Relat Surg Date: 2021-11-19