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

So Young Kim

doi:10.12671/jkfs.2019.32.2.89

Journal List > J Korean Fract Soc > v.32(2) > 1121377

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

Original Article

J Korean Fract Soc 2019;32(2):89-96.

Published online: 10 April 2019

DOI: https://doi.org/10.12671/jkfs.2019.32.2.89

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

So Young Kim, MPH

National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea

Correspondence to: So Young Kim, MPH National Evidence-Based Healthcare Collaborating Agency, Namsan Square 7F, 173 Toegye-ro, Jung-gu, Seoul 04554, Korea Tel: +82-2-2174-2867 Fax: +82-2-2174-2800 E-mail: syni@neca.re.kr

Received 22 January 2019 Revised 10 February 2019 Accepted 22 February 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Femur, Osteoporotic fractures, Bone cements, Systematic reviews

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.

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.

Table 1.

Levels of Evidence

1++	• High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+	• Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias
1–	• Meta-analyses, systematic reviews, or RCTs with a high risk of bias
2++	• High quality systematic reviews of case control or cohort or studies
	• High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is
	causal
2+	• Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship
	is causal
2–	• Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
3	• Non-analytic studies, e.g., case reports, case series
4	• Expert opinion

RCT: randomized controlled trial.

Table 2.

Grades of Recommendations (Health Insurance Review Agency 2005)

A	At least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating the overall consistency of results
B	Body of evidence, including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 1++ or 1+
C	Body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 2++
D	Evidence level 3 or 4; or extrapolated evidence from studies rated as 2+

RCT: randomized controlled trial.

Table 3.

Selected Studies Characteristics

No.	Type	Author (year)	Country	Patients (n)	Intervention (cement)	Quality of study
1	RCT	Dall’Oca et al. (2010) [11]	Italy	Osteoporotic intertrochanteric fractures (80)	Cement augmentation (PMMA)	1+
2	Case series	Lin et al. (2015) [12]	Korea	Osteoporotic femoral neck fractures (6)	Cement augmentation (PMMA)	3
3	Case series	Kammerlander et al. (2014) [13]	Austria	Osteoporotic petrochanteric fractures (62)	Cement augmentation (PMMA)	3
4	Case series	Gupta et al. (2012) [14]	India	Osteoporotic trochanteric fractures (60)	Cement augmentation (PMMA)	3
5	Case series	Kwon et al. (2008) [15]	Korea	Osteoporotic intertrochanteric fractures^* (10)	Cement augmentation (PMMA)	3
6	Case series	Benum (1997) [16]	Norway	Osteoporotic femoral fractures (14)	Cement augmentation (PMMA)	3

^* Treatment of failed intertrochanteric fractures. RCT: randomized controlled trial, PMMA: polymethymethacrylate.

Table 4.

Safety Results: Complications Related to Intervention

No.	Author (year)	Patients (n)	Complications
No.	Author (year)	Patients (n)	% (n)	Specific complications
1	Dall’Oca et al. (2010) [11]	Osteoporotic intertrochanteric fractures (80)	– Intervention: 2.5 (1/40) – Comparator: NA	Cement leakage
2	Lin et al. (2015) [12]	Osteoporotic femoral neck fractures (6)	33.3 (2/6)	Cement leakage
3	Kammerlander et al. (2014) [13]	Osteoporotic petrochanteric fractures (62)	0 (0/62)	–
4	Gupta et al. (2012) [14]	Osteoporotic trochanteric fractures (60)	21.7 (13/60)	Hematoma, infection, urinary retention
5	Benum (1997) [16]	Osteoporotic femoral fractures (14)	0 (0/14)	–

NA: not available.

Table 5.

Effectiveness Results: Improvement of Function

Author (year)	Patients (n)	Improvement of function
Author (year)	Patients (n)	Index	Pre-fracture	Postoperation
Dall’Oca et al. (2010) [11]	Osteoporotic intertrochanteric fractures (80)	HHS	Intervention: 56.49^* Comparator: 56.75^*	Intervention: 59.71^* Comparator: 59.86^*
Kammerlander et al. (2014) [13]	Osteoporotic petrochanteric fractures (62)	Parker score	5.1	4.6
Gupta et al. (2012) [14]	Osteoporotic trochanteric fractures (60)	Normal Walking	96.7%	76.7%
Kwon et al. (2008) [15]	Osteoporotic intertrochanteric fractures^* (10)	Clawson		Good: 30% Moderate: 60% Severe: 10%
Benum (1997) [16]	Osteoporotic femoral fractures (14)	Walking function		Most patients slightly or moderately impaired

^* p>0.05. HHS: Harris's hip score.

Table 6.

Effectiveness Results: Radiological Assessment

Author (year)	Patients (n)	Radiological assessment
Author (year)	Patients (n)	Index	Results
Dall’Oca et al. (2010) [11]	Osteoporotic intertrochanteric fractures (80)	Sliding distance (mm)	Intervention: 12.7^*
			Comparator: 14.2^*
		Cut-out	Intervention: 0%
			Comparator: 0%
Kammerlander et al. (2014) [13]	Osteoporotic petrochanteric fractures (62)	Sliding distance (mm)	5.2
Kammerlander et al. (2014) [13]		Cut-out	0%
Gupta et al. (2012) [14]	Osteoporotic trochanteric fractures (60)	Sliding distance (mm)	3.4

^* p>0.05.

TOOLS

Similar articles