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Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: a randomized study of 118 patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2006 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 77, no 2, 251-256 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We wanted to evaluate whether augmentation with calcium phosphate cement can improve clinical and functional outcome following internal fixation of displaced femoral neck fractures. PATIENTS: 118 patients aged 60-98 years (95 women) were included. All patients were physically active and ambulatory before the fracture. Patients were randomized to treatment with closed reduction and fixation with two cannulated screws alone (controls: 60 patients) or screws combined with injection of calcium phosphate for augmentation around the screw threads and at the fracture site (augmented: 58 patients). All patients were allowed free weight bearing. Clinical and radiographic examinations were done by a physiotherapist directly after surgery, at 1 and 6 weeks, and at 6, 12 and 24 months. RESULTS: 24 patients, 14 augmented and 10 controls, died during the follow-up. There was 1 deep infection (augmented). Another 34 patients were reoperated with a total arthroplasty (20 in the augmented group and 14 controls) due to loss of reduction, nonunion or avascular necrosis (p = 0.1). There was no difference in pain or muscle strength between groups. Some activities of daily living (ADLs) were slightly better in the augmented patients during the first weeks, while there were no differences between groups later on. INTERPRETATION: Due to a trend towards more reoperations in the augmented group, and only a temporary clinical improvement during the early rehabilitation, augmentation as we used it cannot be recommended.

Place, publisher, year, edition, pages
2006. Vol. 77, no 2, 251-256 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-93141DOI: 10.1080/17453670610045984PubMedID: 16752286OAI: oai:DiVA.org:uu-93141DiVA: diva2:166528
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2013-07-10Bibliographically approved
In thesis
1. Resorbable Bone Cement for Augmentation of Hip Fracture
Open this publication in new window or tab >>Resorbable Bone Cement for Augmentation of Hip Fracture
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Surgical treatment of hip fractures is frequently associated with secondary fracture displacement, in part due to weak osteoporotic bone. So far, improvements have focused on new metal implants although an alternative could be to augment the bone that surrounds the implant.

The aim of this thesis was to evaluate the use of calcium phosphate cement (Norian SRS) for augmentation of internally fixed hip fractures. Norian SRS is an injectable, biocompatible cement that hardens in situ without exothermic reaction. Over time it is remodeled and replaced by host bone.

In a biomechanical study the holding characteristics for different implants was measured when inserted with or without augmentation. The study showed that conventional bone cement (PMMA) improved maximum torque and pull-out for almost all modalities while Norian SRS increased the holding power mainly in low-density bone.

In a prospective and randomized study, patients with displaced femoral neck fractures were operated with internal fixation using screws alone or combined with Norian SRS for augmentation. The result showed improved stability when measured with radiostereometry (RSA) for the augmented fractures during the early rehabilitation period. The clinical evaluation of 118 patients included pain, walking aid, activities of daily living (ADLs), abductor muscle strength, mobility and range of motion. During the early course the augmented patients did better in some variables although over the total two-year study period there was no major difference between groups. Scintigraphic evaluation indicated that augmentation might compromise the circulation to the femoral head.

The final part included unstable trochanteric fractures fixed with a sliding screw device alone or the same device combined with Norian SRS for augmentation. Using RSA it was shown that augmentation significantly improved the fracture stability until healing. In a randomized multicenter study including 112 patients, augmentation with Norian SRS reduced pain during early rehabilitation and improved quality of life until healing.

In conclusion, augmentation with Norian SRS improved the early fracture stability in displaced femoral neck fractures while there was no major difference in clinical outcome. In unstable trochanteric fractures augmentation provided improved fracture stability and improved clinical course until healing.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 53 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 46
Keyword
Surgery, Kirurgi
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-5822 (URN)91-554-6271-5 (ISBN)
Public defence
2005-05-31, Grönwallsalen, Akademiska sjukhuset, ing. 70, Uppsala, 09:15
Opponent
Supervisors
Available from: 2005-05-04 Created: 2005-05-04Bibliographically approved

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Mattsson, PerLarsson, Sune

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