The effect of bone substitute on augmentation of internally fixed osteoporotic intertrochanteric fractures

Hsin-Ting Wu ； Fu-Chun Chang ； Pao-Yao Chuang ； Chien-Yin Lee ； Shih-Hsun Shen ； Kuo-Chin Huang ； Tsan-Wen Huang

《Formosan Journal of Musculoskeletal Disorders》 預刊文章 Pp. 1-12

https://doi.org/10.6492/FJMD.202001/PP.0005

摘要

Background: Postoperative complications of osteoporotic intertrochanteric fractures are common despite perfect reduction and optimal fixation. Purpose: To describe a simple technique using bone substitute augmentation to prevent subsequent complications. Methods: Patients with osteoporotic intertrochanteric fractures who received dynamic hip screws (DHSs) from January 2009 to January 2016 were enrolled in this retrospective cohort study and classified into three groups: DHS group: conventional DHS treatment; CADHS group: cement-augmented DHS treatment; and BSA-DHS group: bone substitute-augmented DHS treatment. Demographics, Parker and Palmer mobility, health-related quality of life (short-form Health Survey-12 Physical Component Summary [SF-12- PCS], and SF-12 Mental Component Summary [SF-12-MCS]) scores, morbidities, mortality, and radiographic outcomes were compared. Results: We enrolled 96 patients (DHS group = 37, CA-DHS group = 26, and BSA-DHS group = 33). There was significant lag-screw sliding (mean: 9, 1, and 3 mm, respectively), varus collapse (mean: 7°, 2°, and 3°, respectively), and femoral shortening (mean: 10, 1, and 3 mm, respectively) in the DHS group (p ＜ 0.001 for all three), however differences between the CA-DHS and BSA-DHS groups were nonsignificant. The ability to get around the house was significantly different between the DHS and CA-DHS groups (p = 0.012) and between the DHS and BSA-DHS groups (p = 0.033) at 3 months, but not between the CA-DHS and BSA-DHS groups. Postoperative scores were not significantly different after 6, 9, or 12 months. Ability to get out of the house, go shopping, and SF- 12-PCS scores were significantly worse in the DHS group at 3 and 6 months. Malunion and lag-screw cutout were also significantly worse in the DHS group (p = 0.029 and p = 0.036, respectively).

關鍵字

bone substitute ； cement ； health-related quality of life (HRQoL) ； intertrochanteric fracture ； osteoporosis