Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: a randomized study of 118 patients.
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.


METHODS
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.


CONCLUSIONS
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.
Mattsson
Per
P
Department of Orthopedics, Uppsala University Hospital. Uppsala, SE-751 85. Sweden. Per.Mattsson@surgsci.uu.se
Larsson
Sune
S
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D001863:Bone Screws; D002130:Calcium Phosphates / Q000008:administration & dosage; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome; D016474:Weight-Bearing
D001843:Bone Cements; D002130:Calcium Phosphates