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

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  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

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).

Methods

We searched the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov 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.

Results

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.

Conclusions

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

Level 1

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Acknowledgements

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 (www.editage.jp) for their English editing services.

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan

    Norio Yamamoto

  2. Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan

    Norio Yamamoto, Masahiro Banno & Jun Watanabe

  3. Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Takahisa Ogawa

  4. Department of Psychiatry, Seichiryo Hospital, Tsurumai 4-16-27, Showa-ku, Nagoya, 466-0064, Japan

    Masahiro Banno

  5. Department of Psychiatry, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8560, Japan

    Masahiro Banno

  6. Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu Tottori City, Tottori, 680-0901, Japan

    Jun Watanabe

  7. Center for Community Medicine, Jichi Medical University, 3311-1, Yakushiji Shimotsuke City, Tochigi, 329-0498, Japan

    Jun Watanabe

  8. Department of Musculoskeletal Traumatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan

    Tomoyuki Noda

  9. Department of Orthopedics, Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Boston, USA

    Haggai Schermann

  10. Department of Orthopaedic Surgery, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, Okayama, Japan

    Toshifumi Ozaki

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  1. Norio Yamamoto
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  2. Takahisa Ogawa
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  5. Tomoyuki Noda
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Contributions

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). https://doi.org/10.1007/s00068-021-01746-5

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  • DOI: https://doi.org/10.1007/s00068-021-01746-5

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