J Korean Fract Soc.  2019 Apr;32(2):89-96. 10.12671/jkfs.2019.32.2.89.

Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews

• Kim SY

• KMID: 2443110
• DOI: http://doi.org/10.12671/jkfs.2019.32.2.89

Abstract

PURPOSE
This paper reviewed the safety and effectiveness of anchor augmentation with bone cement in osteoporotic femoral fractures.
MATERIALS AND METHODS
A systematic review was conducted by searching multiple databases including five Korean databases, Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library. Safety was assessed through the incidence of complication. The effectiveness was assessed through the failure rate of anchor fixation, improvement of function and radiological assessment (sliding distance of lag screw and cutout). The safety and effectiveness of anchor augmentation with bone cement were assessed by reviewing all articles reporting on the treatment. Two researchers carried out independently each stage from the literature search to data extraction. The tools of Scottish Intercollegiate Guidelines Networks were used to assess the quality of studies.
RESULTS
Six studies were considered eligible. The safety results revealed a small amount of cement leakage (1 case), but no other severe complications were encountered. Regarding the effectiveness, the failure rate of anchor fixation was 16.7% and the Harris's hip score showed no significant improvement. The sliding distance of the anchor was similar in the cement augmentation group and non-cement group but there was no cutout.
CONCLUSION
The results of the assessment suggest that the safety is acceptable, but further research will be needed to verify the effectiveness of the treatment.

Keyword

Femur; Osteoporotic fractures; Bone cements; Systematic reviews

MeSH Terms

Bone Cements
Femoral Fractures*
Femur
Hip
Incidence
Osteoporotic Fractures
Bone Cements

Figure

• 

  Fig. 1. Study flowchart. Searching through the literature identified 1,824 documents. Of these, 196 studies duplicated data from other reports and were excluded. 1,622 studies did not meet the inclusion criteria. A total of six studies were included in the final evaluation.

Reference

References

1. The Korean Orthopaedic Association: Orthopedics. 6th ed.Seoul: Choisin Euihak;2006.

2. Min BW, LEE KJ. Treatment of intertrochanteric fracture: dynamic hip screw. J Korean Fract Soc. 22:51–55. 2009.

3. Goldhagen PR, O'Connor DR, Schwarze D, Schwartz E. A prospective comparative study of the compression hip screw and the gamma nail. J Orthop Trauma. 8:367–372. 1994.

4. Choueka J, Koval KJ, Kummer FJ, Crawford G, Zuckerman JD. Biomechanical comparison of the sliding hip screw and the dome plunger. Effects of material and fixation design. J Bone Joint Surg Br. 77:277–283. 1995.

5. Jiang LS, Shen L, Dai LY. Intramedullary fixation of subtrochanteric fractures with long proximal femoral nail or long gamma nail: technical notes and preliminary results. Ann Acad Med Singapore. 36:821–826. 2007.

6. Larsson S, Elloy M, Hansson LI. Stability of osteosynthesis in trochanteric fractures. Comparison of three fixation devices in cadavers. Acta Orthop Scand. 59:386–390. 1988.

7. Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Strømsøe K. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma. 12:241–248. 1998.

8. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 62:1006–1012. 2009.

9. Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Check-etts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 72:26–31. 1990.

10. Scottish Intercollegiate Guidelines Network. Methodology checklists [Internet]. Edinburgh, Scottish Intercollegiate Guidelines Network: 2011 [cited 2018 Jun 1]. Available from:. https://www.sign.ac.uk/checklists-and-notes.html.

11. Dall'Oca C, Maluta T, Moscolo A, Lavini F, Bartolozzi P. Cement augmentation of intertrochanteric fractures stabilised with intramedullary nailing. Injury. 41:1150–1155. 2010.

12. Lin PP, Kang HG, Kim YI, Kim JH, Kim HS. Minimally invasive surgery for femoral neck fractures using bone cement infusible hollow-perforated screw in high-risk patients with advanced cancer. Surg Oncol. 24:226–231. 2015.

13. Kammerlander C, Doshi H, Gebhard F, et al. Long-term results of the augmented PFNA: a prospective multicenter trial. Arch Orthop Trauma Surg. 134:343–349. 2014.

14. Gupta RK, Gupta V, Gupta N. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw. Indian J Orthop. 46:640–645. 2012.

15. Kwon SY, Park HW, Lee SU, et al. Treatment of failed intertrochanteric fractures to maintain the reduction in elderly patients. J Korean Fract Soc. 21:267–273. 2008.

16. Benum P. The use of bone cement as an adjunct to internal fixation of supracondylar fractures of osteoporotic femurs. Acta Orthop Scand. 48:52–56. 1997.

17. Park SY, Lee SH, Jeong WK, Kang CH. Surgical or nonsurgical treatment of osteoporotic fractures. J Korean Med Assoc. 59:857–865. 2016.

18. Laros GS, Moore JF. Complications of fixation in intertrochanteric fractures. Clin Orthop Relat Res. 101:110–119. 1974.

19. Rha JD, Kim YH, Yoon SI, Park TS, Lee MH. Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop. 17:320–324. 1993.

20. Lee JH, Kang SB, Park JS, Moon SH, Yoon KS. Fixation failure after internal fixation in intertrochanteric fractures. J Korean Orthop Assoc. 32:1718–1724. 1997.

21. Kim SS, Sohn SK, Lee MJ, Kang MS, Kim SK. Analysis of failures of union of the intertrochanteric femoral fractures. J Korean Fract Soc. 16:456–464. 2003.

22. Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand. 51:803–810. 1980.

23. Mulholland RC, Gunn DR. Sliding screw plate fixation of intertrochanteric femoral fractures. J Trauma. 12:581–591. 1972.

24. Struhl S, Szporn MN, Cobelli NJ, Sadler AH. Cemented internal fixation for supracondylar femur fractures in osteoporotic patients. J Orthop Trauma. 4:151–157. 1990.

25. Kim BJ, Lee SJ, Kwon SY, Track GR, Lee GY. A biomechanical study on a new surgical procedure for the treatment of intertrochanteric fractures in relation to osteoporosis of varying degrees. J Biomed Eng Res. 24:401–410. 2003.