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

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.