Abstract
Treatment of fractures of the proximal femur is associated with an increased risk of complications in case of osteoporosis: loss of reduction, implant cut out or failure of osteosynthesis. One possible solution presented in the literature is augmentation of implant with bone cement PMBA.
Opponents of augmentation report negative aspects of cement toxicity, healing inhibition, prolongation of surgical time, price. Osteosynthesis failure can be documented by disturbing the balance between compressive and tension forces and by overloading the mechanical fixation properties.
Both imperfect reduction and osteosynthesis is the reason of failure, fixation stiffness and bone quality (lower bone marrow density) are involved. It remains a question of how bone quality affects healing or whether bone quality is responsible for the failure of osteosynthesis.
From 2011 to 2016, at our department we treated 478 patients with unstable per-trochanteric fracture. From this number, we created 2 groups of patients.
The first one included patients without signs of osteoporosis on plain radiographic examination. Patients with significant skeletal quality changes were enrolled second group.
There were 59 men and 28 women in the first group. The mean age in this group was 42 years (19-55).
The second group was consisted of 221 patients, 51 men and 170 women. The mean age was over 77 years (75-92).
The results in both groups did not differ significantly. Gross majority of fractures (93 %) was healed within 6 months.
Number of complications - healing failure 2.5 %, failure of osteosynthesis up to 5 %. Only the number of total complications was different.
Indications for the use of bone cement augmented are significant osteoporosis of the skeleton, conditions after failure of osteosynthesis, pathological fractures (e.g. every condition, in which an increased implant stiffness is important).