The effects of bone-substitute augmentation on treatment of osteoporotic intertrochanteric fractures

Fu-Chun Chang; Pao-Yao Chuang; Ching-Yu Lee; Chien-Yin Lee; Ying-Chao Chou; Tsan-Wen Huang; Kuo-Chin Huang; Hsin-Nung Shih; Mel S Lee

doi:10.1016/j.bj.2020.05.013

The effects of bone-substitute augmentation on treatment of osteoporotic intertrochanteric fractures

Biomed J. 2021 Dec;44(6):717-726. doi: 10.1016/j.bj.2020.05.013. Epub 2020 May 23.

Authors

Fu-Chun Chang¹, Pao-Yao Chuang², Ching-Yu Lee³, Chien-Yin Lee², Ying-Chao Chou⁴, Tsan-Wen Huang⁵, Kuo-Chin Huang⁶, Hsin-Nung Shih⁴, Mel S Lee⁷

Affiliations

¹ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Yunlin, Yunlin, Taiwan.
² Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
³ Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
⁴ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Gueishan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan; Chang Gung University, Taoyuan, Taiwan. Electronic address: b8601081@cgmh.org.tw.
⁶ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan; Chang Gung University, Taoyuan, Taiwan.
⁷ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Chang Gung University, Taoyuan, Taiwan.

Abstract

Background: Osteoporotic intertrochanteric fractures often have postoperative complications despite a perfect reduction and an optimal fixation. We describe a simple technique using bone substitute augmentation and hypothesize that this method would prevent excessive sliding of the lag screw and potential subsequent complications.

Methods: Between January 2009 and July 2017, patients with osteoporotic intertrochanteric fractures who were treated with a dynamic hip screw (DHS) were enrolled in this retrospective cohort study. DHS group patients received conventional DHS treatment and BSA-DHS group patients received bone-substitute augmented DHS treatment. Factors such as demographics, Parker and Palmer mobility scores, health-related quality of life (HRQoL) scores (short-form Health Survey-12 Physical Component Summary [SF-12-PCS], and SF-12 Mental Component Summary [SF-12-MCS]), morbidities, mortality, and radiographic outcomes were compared.

Results: We enrolled 85 patients: DHS group = 37 and BSA-DHS group = 48. There was significant lag-screw sliding (mean: 9 mm and 3 mm, p < 0.001), varus collapse (mean: 7° and 3°, p < 0.001), and femoral shortening (mean: 10 mm and 3 mm, p < 0.001) in the DHS group compared to the BSA-DHS group. The ability to get around the house was significantly different between the DHS and BSA-DHS groups (p = 0.031) at 3 months. Postoperative scores were not significantly different after 6, 9 or 12 months, however. Scores for the ability to get out of the house and to go shopping and the SF-12-PCS 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 = 0.037 and p = 0.033, respectively).

Conclusions: Bone-substitute augmentation appears effective to prevent typical postoperative complications experienced by the DHS group patients, and to improve functional outcomes. Additional prospective randomized large-scale cohort studies are necessary to confirm this conclusion.

Level of evidence: Therapeutic Level III.

Keywords: Bone substitute; Health-related quality of life (HRQoL); Intertrochanteric fracture; Osteoporosis.

MeSH terms

Bone Substitutes*
Fracture Fixation, Internal / methods
Fracture Healing
Hip Fractures* / surgery
Humans
Prospective Studies
Quality of Life
Retrospective Studies
Treatment Outcome

Substances

Bone Substitutes