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Resorbable Bone Cement for Augmentation of Hip Fracture
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Surgical treatment of hip fractures is frequently associated with secondary fracture displacement, in part due to weak osteoporotic bone. So far, improvements have focused on new metal implants although an alternative could be to augment the bone that surrounds the implant.

The aim of this thesis was to evaluate the use of calcium phosphate cement (Norian SRS) for augmentation of internally fixed hip fractures. Norian SRS is an injectable, biocompatible cement that hardens in situ without exothermic reaction. Over time it is remodeled and replaced by host bone.

In a biomechanical study the holding characteristics for different implants was measured when inserted with or without augmentation. The study showed that conventional bone cement (PMMA) improved maximum torque and pull-out for almost all modalities while Norian SRS increased the holding power mainly in low-density bone.

In a prospective and randomized study, patients with displaced femoral neck fractures were operated with internal fixation using screws alone or combined with Norian SRS for augmentation. The result showed improved stability when measured with radiostereometry (RSA) for the augmented fractures during the early rehabilitation period. The clinical evaluation of 118 patients included pain, walking aid, activities of daily living (ADLs), abductor muscle strength, mobility and range of motion. During the early course the augmented patients did better in some variables although over the total two-year study period there was no major difference between groups. Scintigraphic evaluation indicated that augmentation might compromise the circulation to the femoral head.

The final part included unstable trochanteric fractures fixed with a sliding screw device alone or the same device combined with Norian SRS for augmentation. Using RSA it was shown that augmentation significantly improved the fracture stability until healing. In a randomized multicenter study including 112 patients, augmentation with Norian SRS reduced pain during early rehabilitation and improved quality of life until healing.

In conclusion, augmentation with Norian SRS improved the early fracture stability in displaced femoral neck fractures while there was no major difference in clinical outcome. In unstable trochanteric fractures augmentation provided improved fracture stability and improved clinical course until healing.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2005. , p. 53
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 46
Keywords [en]
Surgery
Keywords [sv]
Kirurgi
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-5822ISBN: 91-554-6271-5 (print)OAI: oai:DiVA.org:uu-5822DiVA, id: diva2:166532
Public defence
2005-05-31, Grönwallsalen, Akademiska sjukhuset, ing. 70, Uppsala, 09:15
Opponent
Supervisors
Available from: 2005-05-04 Created: 2005-05-04Bibliographically approved
List of papers
1. The effect of augmentation with resorbable or conventional bone cement on holding power for femoral neck fracture devices
Open this publication in new window or tab >>The effect of augmentation with resorbable or conventional bone cement on holding power for femoral neck fracture devices
2002 In: J Orthop Trauma, Vol. 16, no 5, p. 302-310Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-93139 (URN)
Available from: 2005-05-04 Created: 2005-05-04Bibliographically approved
2. Stability of internally fixed femoral neck fractures augmented with resorbable cement
Open this publication in new window or tab >>Stability of internally fixed femoral neck fractures augmented with resorbable cement
2003 In: Scand J Surg, no 92, p. 215-219Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-93140 (URN)
Available from: 2005-05-04 Created: 2005-05-04Bibliographically approved
3. Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: a randomized study of 118 patients
Open this publication in new window or tab >>Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: a randomized study of 118 patients
2006 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 77, no 2, p. 251-256Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We wanted to evaluate whether augmentation with calcium phosphate cement can improve clinical and functional outcome following internal fixation of displaced femoral neck fractures. PATIENTS: 118 patients aged 60-98 years (95 women) were included. All patients were physically active and ambulatory before the fracture. Patients were randomized to treatment with closed reduction and fixation with two cannulated screws alone (controls: 60 patients) or screws combined with injection of calcium phosphate for augmentation around the screw threads and at the fracture site (augmented: 58 patients). All patients were allowed free weight bearing. Clinical and radiographic examinations were done by a physiotherapist directly after surgery, at 1 and 6 weeks, and at 6, 12 and 24 months. RESULTS: 24 patients, 14 augmented and 10 controls, died during the follow-up. There was 1 deep infection (augmented). Another 34 patients were reoperated with a total arthroplasty (20 in the augmented group and 14 controls) due to loss of reduction, nonunion or avascular necrosis (p = 0.1). There was no difference in pain or muscle strength between groups. Some activities of daily living (ADLs) were slightly better in the augmented patients during the first weeks, while there were no differences between groups later on. INTERPRETATION: Due to a trend towards more reoperations in the augmented group, and only a temporary clinical improvement during the early rehabilitation, augmentation as we used it cannot be recommended.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-93141 (URN)10.1080/17453670610045984 (DOI)16752286 (PubMedID)
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2017-12-14Bibliographically approved
4. Augmentation of femoral neck fractures with calcium-phosphate cement. Randomized scintimetric study of femoral head viability in 94 patients
Open this publication in new window or tab >>Augmentation of femoral neck fractures with calcium-phosphate cement. Randomized scintimetric study of femoral head viability in 94 patients
In: J Bne Joint Surg (A)Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:uu:diva-93142 (URN)
Available from: 2005-05-04 Created: 2005-05-04Bibliographically approved
5. Unstable trochanteric fractures augmented with calcium phosphate cement. A prospective randomized study using radiostereometry to measure fracture stability
Open this publication in new window or tab >>Unstable trochanteric fractures augmented with calcium phosphate cement. A prospective randomized study using radiostereometry to measure fracture stability
2004 In: Scand J Surg, no 93, p. 223-228Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-93143 (URN)
Available from: 2005-05-04 Created: 2005-05-04Bibliographically approved
6. Resorbable cement for augmentation of internally fixed unstable trochanteric fractures: A prospective randomised multicenter study
Open this publication in new window or tab >>Resorbable cement for augmentation of internally fixed unstable trochanteric fractures: A prospective randomised multicenter study
Show others...
2005 (English)In: Journal of Bone and Joint Surgery, ISSN 0301-620X, E-ISSN 2044-5377, Vol. 87, no 9, p. 1203-1209Article in journal (Refereed) Published
Abstract [en]

We undertook a multicentre, prospective study of a series of 112 unstable trochanteric fractures in order to evaluate if internal fixation with a sliding screw device combined with augmentation using a calcium phosphate degradable cement (Norian SRS) could improve the clinical, functional and radiological outcome when compared with fractures treated with a sliding screw device alone. Pain, activities of daily living, health status (SF-36), the strength of the hip abductor muscles and radiological outcome were analysed. Six weeks after surgery, the patients in the augmented group had significantly lower global and functional pain scores (p < 0.003), less pain after walking 50 feet (p < 0.01), and a better return to the activities of daily living (p < 0.05). At follow-up at six weeks and six months, those in the augmented group showed a significant improvement compared with the control group in the SF-36 score. No other significant differences were found between the groups. We conclude that augmentation with calcium phosphate cement in unstable trochanteric fractures provides a modest reduction in pain and a slight improvement in the quality of life during the course of healing when compared with conventional fixation with a sliding screw device alone.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-93144 (URN)10.1302/0301-620X.87B9.15792 (DOI)16129742 (PubMedID)
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2017-12-14Bibliographically approved

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