Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies
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 energ...
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| Veröffentlicht in: | PloS one 2021-06, Vol.16 (6), p.e0251894-e0251894 |
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| creator | Rompen, Ingmar F Knobe, Matthias Link, Bjoern-Christian Beeres, Frank J. P Baumgaertner, Ralf Diwersi, Nadine Migliorini, Filippo Nebelung, Sven Babst, Reto van de Wall, Bryan J. M |
| description | 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. 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. 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. 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. |
| doi_str_mv | 10.1371/journal.pone.0251894 |
| format | Article |
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P ; Baumgaertner, Ralf ; Diwersi, Nadine ; Migliorini, Filippo ; Nebelung, Sven ; Babst, Reto ; van de Wall, Bryan J. M</creator><contributor>Simmen, Hans-Peter</contributor><creatorcontrib>Rompen, Ingmar F ; Knobe, Matthias ; Link, Bjoern-Christian ; Beeres, Frank J. P ; Baumgaertner, Ralf ; Diwersi, Nadine ; Migliorini, Filippo ; Nebelung, Sven ; Babst, Reto ; van de Wall, Bryan J. M ; Simmen, Hans-Peter</creatorcontrib><description>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. 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. 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. 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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0251894</identifier><identifier>PMID: 34129607</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Aged patients ; Biology and Life Sciences ; Bone cements ; Bone healing ; Care and treatment ; Cement ; Clinical trials ; Complications ; Complications and side effects ; Confidence intervals ; Diagnosis ; Editing ; Engineering and Technology ; Extrusion ; Femur ; Fractures ; Hematoma ; Hip ; Infections ; Injuries ; Internal fixation in fractures ; Irritation ; Medicine ; Medicine and Health Sciences ; Meta-analysis ; Mortality ; Nonunion ; Observational studies ; Older people ; Orthopedics ; Pain ; Patient outcomes ; Physical Sciences ; Population number ; Population studies ; Quality of life ; Radiology ; Research and Analysis Methods ; Statistical analysis ; Surgery ; Thromboembolism ; Trauma ; Wounds</subject><ispartof>PloS one, 2021-06, Vol.16 (6), p.e0251894-e0251894</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Rompen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Rompen et al 2021 Rompen et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c669t-4740a412710651438bda3a8b958513b0c4eac901d2860cf4a22da8e2c2b567963</citedby><cites>FETCH-LOGICAL-c669t-4740a412710651438bda3a8b958513b0c4eac901d2860cf4a22da8e2c2b567963</cites><orcidid>0000-0002-0257-1654</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205169/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205169/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids></links><search><contributor>Simmen, Hans-Peter</contributor><creatorcontrib>Rompen, Ingmar F</creatorcontrib><creatorcontrib>Knobe, Matthias</creatorcontrib><creatorcontrib>Link, Bjoern-Christian</creatorcontrib><creatorcontrib>Beeres, Frank J. P</creatorcontrib><creatorcontrib>Baumgaertner, Ralf</creatorcontrib><creatorcontrib>Diwersi, Nadine</creatorcontrib><creatorcontrib>Migliorini, Filippo</creatorcontrib><creatorcontrib>Nebelung, Sven</creatorcontrib><creatorcontrib>Babst, Reto</creatorcontrib><creatorcontrib>van de Wall, Bryan J. M</creatorcontrib><title>Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies</title><title>PloS one</title><description>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. 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. 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. 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.</description><subject>Aged patients</subject><subject>Biology and Life Sciences</subject><subject>Bone cements</subject><subject>Bone healing</subject><subject>Care and treatment</subject><subject>Cement</subject><subject>Clinical trials</subject><subject>Complications</subject><subject>Complications and side effects</subject><subject>Confidence intervals</subject><subject>Diagnosis</subject><subject>Editing</subject><subject>Engineering and Technology</subject><subject>Extrusion</subject><subject>Femur</subject><subject>Fractures</subject><subject>Hematoma</subject><subject>Hip</subject><subject>Infections</subject><subject>Injuries</subject><subject>Internal fixation in fractures</subject><subject>Irritation</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Nonunion</subject><subject>Observational studies</subject><subject>Older people</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Patient outcomes</subject><subject>Physical Sciences</subject><subject>Population number</subject><subject>Population studies</subject><subject>Quality of life</subject><subject>Radiology</subject><subject>Research and Analysis Methods</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Thromboembolism</subject><subject>Trauma</subject><subject>Wounds</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12L1DAUhoso7rr6DwQDgujFjEnapK0XwjD4MbCw4NdtOE1PZzK0zZikiyv4301nqmxlL6QXKTlP3vPmJSdJnjK6ZGnOXu_t4Hpolwfb45JywYoyu5ecszLlC8lpev_W_1nyyPs9pSItpHyYnKUZ46Wk-Xnya40d9oHAsB1XCMb2pLGOBGf1DvqAzmjSYDc40jjQYXDo35AV6TDAAqKBG288sQ1x0Ne2Mz-xJro1vdHQRhEDrSexQmzl0V0f9WPBh6E26B8nD5oI4JNpvUi-vn_3Zf1xcXn1YbNeXS60lGVYZHlGIVrOGZWCZWlR1ZBCUZWiECytqM4QdElZzQtJdZMB5zUUyDWvhMxLmV4kz066h9Z6NSXnFRfHHBgtI7E5EbWFvTo404G7URaMOm5Yt1XggtEtKl7pgtZ5U6JOsyL2yHSNQte6KqJLbKLW26nbUHVY65irg3YmOq_0Zqe29loVnAomRzMvJwFnvw_og-qM19i20KMdTr7zIpcijejzf9C7bzdRW4gXMH1jY189iqqVlIKXXAoRqeUdVPxq7IyOz6wxcX924NXsQGQC_ghbGLxXm8-f_p-9-jZnX9xidwht2HnbDuPj8XMwO4HaWe8dNn9DZlSNU_InDTVOiZqmJP0NNQkFXg</recordid><startdate>20210615</startdate><enddate>20210615</enddate><creator>Rompen, Ingmar F</creator><creator>Knobe, Matthias</creator><creator>Link, Bjoern-Christian</creator><creator>Beeres, Frank J. 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P</au><au>Baumgaertner, Ralf</au><au>Diwersi, Nadine</au><au>Migliorini, Filippo</au><au>Nebelung, Sven</au><au>Babst, Reto</au><au>van de Wall, Bryan J. M</au><au>Simmen, Hans-Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies</atitle><jtitle>PloS one</jtitle><date>2021-06-15</date><risdate>2021</risdate><volume>16</volume><issue>6</issue><spage>e0251894</spage><epage>e0251894</epage><pages>e0251894-e0251894</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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. 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. 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. 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.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>34129607</pmid><doi>10.1371/journal.pone.0251894</doi><tpages>e0251894</tpages><orcidid>https://orcid.org/0000-0002-0257-1654</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-06, Vol.16 (6), p.e0251894-e0251894 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2541296109 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged patients Biology and Life Sciences Bone cements Bone healing Care and treatment Cement Clinical trials Complications Complications and side effects Confidence intervals Diagnosis Editing Engineering and Technology Extrusion Femur Fractures Hematoma Hip Infections Injuries Internal fixation in fractures Irritation Medicine Medicine and Health Sciences Meta-analysis Mortality Nonunion Observational studies Older people Orthopedics Pain Patient outcomes Physical Sciences Population number Population studies Quality of life Radiology Research and Analysis Methods Statistical analysis Surgery Thromboembolism Trauma Wounds |
| title | Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies |
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