Augmentation in fragility fractures, bone of contention: a systematic review

Abstract

Background Osteoporosis is a complex multifactorial disease characterized by reduced bone mass and microarchitectural deterioration of bone tissue linked to an increase of fracture risk. Fragility fractures occur in osteoporotic subjects due to low-energy trauma. Osteoporotic patients are a challenge regarding the correct surgical planning, as it can include fixation augmentation techniques to reach a more stable anchorage of the implant, possibly lowering re-intervention rate and in-hospital stay. Methods The PubMed database and the Google Scholar search engine were used to identify articles on all augmentation techniques and their association with fragility fractures until January 2022. In total, we selected 40 articles that included studies focusing on humerus, hip, spine, and tibia. Results Literature review showed a quantity of materials that can be used for reconstruction of bone defects in fragility fractures in different anatomic locations, with good results over the stability and strength of the implant anchorage, when compared to non-augmented fractures. Conclusion Nowadays there are no recommendations and no consensus about the use of augmentation techniques in osteoporotic fractures. Our literature review points at implementing the use of bone augmentation techniques with a specific indication for elderly patients with comminuted fractures and poor bone quality.

Intramedullary Kirschner Wire Fixation for Metatarsal Fractures: A Comprehensive Review of Treatment Outcomes

“…Assessing bone quality through preoperative imaging studies, such as dual-energy X-ray absorptiometry (DEXA) scans, assists surgeons in making informed decisions about the suitability of intramedullary fixation. This consideration emphasizes the importance of tailoring the surgical approach to the specific biomechanical characteristics of the patient's bones [ 15 ].…”

In Vitro Osteogenesis Study of Shell Nacre Cement with Older and Young Donor Bone Marrow Mesenchymal Stem/Stromal Cells

“…The treatment strategies for managing bone loss and bone voids include augmentation techniques involving bone grafts or a range of bone cements or ceramics [23][24][25][26][27]. Polymethyl methacrylate (PMMA) is widely used in various clinical settings, such as in the treatment of fragility fractures [28], vertebral compression fractures [29], revision arthroplasty defects [30][31][32], and bone voids after infection [33] or tumour resections [34]. While PMMA offers the required moldability and mechanical strength, it lacks essential biological properties and resorbability [35][36][37].…”

A meta‐analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures

“…However, there is currently no consensus on the choice of artificial hip joint prosthesis in clinical practice, with the primary focus being on the selection between cemented and uncemented prostheses. Some studies suggest that cemented prostheses can provide better stability and lower incidence of surgical site infections after surgery; however, these may be difficult to revise and may cause arrhythmia, decreased oxygen saturation, hypotension, and other cardiovascular complications during the surgical procedure 7–9 . In contrast, uncemented prostheses have advantages in terms of reduced blood loss and shorter intraoperative time but may exhibit a higher rate of postoperative loosening and poor fixation 10,11 .…”

“…Some studies suggest that cemented prostheses can provide better stability and lower incidence of surgical site infections after surgery; however, these may be difficult to revise and may cause arrhythmia, decreased oxygen saturation, hypotension, and other cardiovascular complications during the surgical procedure. [7][8][9] In contrast, uncemented prostheses have advantages in terms of reduced blood loss and shorter intraoperative time but may exhibit a higher rate of postoperative loosening and poor fixation. 10,11 To further investigate the application of cemented and uncemented artificial hip joint prostheses in femoral neck fractures, this study aimed to compare the differences in surgical site infections, postoperative wound pain, and pressure sore incidence between the two fixation methods.…”