Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.

Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.

<h4>Introduction</h4>To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (...

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Autores principales: Ingmar F Rompen, Matthias Knobe, Bjoern-Christian Link, Frank J P Beeres, Ralf Baumgaertner, Nadine Diwersi, Filippo Migliorini, Sven Nebelung, Reto Babst, Bryan J M van de Wall
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Publicado: Public Library of Science (PLoS) 2021
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spelling oai:doaj.org-article:2bc80d7f9ec348c2b4cde5cdcb80a4ef2021-12-02T20:03:52ZCement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.1932-620310.1371/journal.pone.0251894https://doaj.org/article/2bc80d7f9ec348c2b4cde5cdcb80a4ef2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251894https://doaj.org/toc/1932-6203<h4>Introduction</h4>To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (>65 years) following low energy trauma.<h4>Methods</h4>PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. Subgroup analysis was performed stratified by study design (RCTs and observational studies). The primary outcome is overall complication rate. Secondary outcomes include re-operation rate, mortality, operation duration, hospital stay, general quality of life, radiologic measures and functional hip scores.<h4>Results</h4>A total of four RCT's (437 patients) and three observational studies (293 patients) were included. The effect estimates of RCTs were equal to those obtained from observational studies. Cement augmentation has a significantly lower overall complication rate (28.3% versus 47.2%) with an odds ratio (OR) of 0.3 (95%CI 0.1-0.7). The occurrence of device/fracture related complications was the largest contributing factor to this higher overall complication rate in the non-augmented group (19.9% versus 6.0%, OR 0.2, 95%CI 0.1-0.6). Cement augmentation also carries a lower risk for re-interventions (OR 0.2, 95%CI 0.1-0.7) and shortens the hospital stay with 2 days (95%CI -2.2 to -0.5 days). The mean operation time was 7 minutes longer in the augmented group (95%CI 1.3-12.9). Radiological scores (lag screw/blade sliding mean difference -3.1mm, 95%CI -4.6 to -1.7, varus deviation mean difference -6.15°, 95%CI; -7.4 to -4.9) and functional scores (standardized mean difference 0.31, 95%CI 0.0-0.6) were in favor of cement augmentation. Mortality was equal in both groups (OR 0.7, 95%CI 0.4-1.3) and cement related complications were rare.<h4>Conclusion</h4>Cement augmentation in fixation of trochanteric femoral fractures leads to fewer complications, re-operations and shorter hospital stay at the expense of a slightly longer operation duration. Cementation related complications occur rarely and mortality is equal between treatment groups. Based on these results, cement augmentation should be considered for trochanteric fractures in elderly patients.Ingmar F RompenMatthias KnobeBjoern-Christian LinkFrank J P BeeresRalf BaumgaertnerNadine DiwersiFilippo MiglioriniSven NebelungReto BabstBryan J M van de WallPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0251894 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Ingmar F Rompen
Matthias Knobe
Bjoern-Christian Link
Frank J P Beeres
Ralf Baumgaertner
Nadine Diwersi
Filippo Migliorini
Sven Nebelung
Reto Babst
Bryan J M van de Wall
Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.
description <h4>Introduction</h4>To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (>65 years) following low energy trauma.<h4>Methods</h4>PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. Subgroup analysis was performed stratified by study design (RCTs and observational studies). The primary outcome is overall complication rate. Secondary outcomes include re-operation rate, mortality, operation duration, hospital stay, general quality of life, radiologic measures and functional hip scores.<h4>Results</h4>A total of four RCT's (437 patients) and three observational studies (293 patients) were included. The effect estimates of RCTs were equal to those obtained from observational studies. Cement augmentation has a significantly lower overall complication rate (28.3% versus 47.2%) with an odds ratio (OR) of 0.3 (95%CI 0.1-0.7). The occurrence of device/fracture related complications was the largest contributing factor to this higher overall complication rate in the non-augmented group (19.9% versus 6.0%, OR 0.2, 95%CI 0.1-0.6). Cement augmentation also carries a lower risk for re-interventions (OR 0.2, 95%CI 0.1-0.7) and shortens the hospital stay with 2 days (95%CI -2.2 to -0.5 days). The mean operation time was 7 minutes longer in the augmented group (95%CI 1.3-12.9). Radiological scores (lag screw/blade sliding mean difference -3.1mm, 95%CI -4.6 to -1.7, varus deviation mean difference -6.15°, 95%CI; -7.4 to -4.9) and functional scores (standardized mean difference 0.31, 95%CI 0.0-0.6) were in favor of cement augmentation. Mortality was equal in both groups (OR 0.7, 95%CI 0.4-1.3) and cement related complications were rare.<h4>Conclusion</h4>Cement augmentation in fixation of trochanteric femoral fractures leads to fewer complications, re-operations and shorter hospital stay at the expense of a slightly longer operation duration. Cementation related complications occur rarely and mortality is equal between treatment groups. Based on these results, cement augmentation should be considered for trochanteric fractures in elderly patients.
format article
author Ingmar F Rompen
Matthias Knobe
Bjoern-Christian Link
Frank J P Beeres
Ralf Baumgaertner
Nadine Diwersi
Filippo Migliorini
Sven Nebelung
Reto Babst
Bryan J M van de Wall
author_facet Ingmar F Rompen
Matthias Knobe
Bjoern-Christian Link
Frank J P Beeres
Ralf Baumgaertner
Nadine Diwersi
Filippo Migliorini
Sven Nebelung
Reto Babst
Bryan J M van de Wall
author_sort Ingmar F Rompen
title Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.
title_short Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.
title_full Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.
title_fullStr Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.
title_full_unstemmed Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.
title_sort cement augmentation for trochanteric femur fractures: a meta-analysis of randomized clinical trials and observational studies.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/2bc80d7f9ec348c2b4cde5cdcb80a4ef
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