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Cement augmentation of internal fixation for trochanteric fracture: a systematic review and meta-analysis



This study aimed to determine the efficacy and safety of cement augmentation for internally fixed trochanteric fractures through a systematic review and meta-analysis of randomized controlled trials (RCTs).


We searched the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and databases to identify RCTs, published until July 2020 that examined the effects of cement augmentation of internal fixation of trochanteric fractures. The primary outcomes were reoperation and Parker Mobility Score, whereas the secondary outcomes were 1-year mortality rate, EuroQol 5 Dimension, fixation failures, and adverse events. We conducted meta-analyses of the outcome measures using the random-effects models. We evaluated the certainty of evidence based on the Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach.


We included three RCTs (326 participants). No significant effect was observed in favor of cement augmentation on all these outcomes. The certainty of evidence for fixation failures was very low and that for the other outcomes was low. The overall risk of bias for each outcome was high or of some concern in all included studies.


The effect of cement augmentation of internal fixation of trochanteric fractures was uncertain for the clinical outcomes due to the low certainty of evidence. Further RCTs with a low risk of selection bias may present convincing conclusions on the efficacy and safety of cement augmentation.

Level of evidence

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We thank Dr. Yasushi Tsujimoto for providing the detailed information on the sensitivity analysis. This work was supported by the Systematic Review Workshop Peer Support Group (SRWS-PSG). We thank Editage ( for their English editing services.


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Author information

Authors and Affiliations



All authors contributed to the study conception and design. Data collection was performed by NY, TO, and HS. Data analysis was performed by NY, TO, JW, and MB. The first draft of the manuscript was written by NY and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Norio Yamamoto.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary Information

Below is the link to the electronic supplementary material.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2009 checklist (DOCX 35 KB)

Search strategy (DOCX 20 KB)

Risk of bias graph for 1-year mortality rate (TIF 69 KB)

Risk of bias summary for 1-year mortality rate (TIF 69 KB)

Risk of bias graph for fixation failure (TIF 69 KB)

Risk of bias summary for fixation failure (TIF 72 KB)

Forest plot of comparison: Functional outcome (TIF 111 KB)

Forest plot of comparison for reoperation: subgroup analysis by fracture type (TIF 105 KB)

Forest plot of comparison for reoperation: subgroup analysis by implant type (TIF 104 KB)

Forest plot of comparison for reoperation: subgroup analysis by cement type (TIF 103 KB)

Sensitivity analysis for reoperation of the missing participants using informative missingness odds ratios (TIF 32 KB)

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Yamamoto, N., Ogawa, T., Banno, M. et al. Cement augmentation of internal fixation for trochanteric fracture: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 48, 1699–1709 (2022).

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  • Trochanteric fracture
  • Cement augmentation
  • Systematic review
  • Meta-analysis