[Cement augmentation in pertrochanteric fractures : Evidence, indication and surgical application]

Cement augmentation of cephalomedullary implants was developed to improve anchorage of the head element in osteoporotic pertrochanteric fractures and to reduce implant-related failure patterns such as cut-out or excessive sliding. The aim of this review article is to provide a clinical classification of cement augmentation in pertrochanteric fractures, with particular focus on clinical and socioeconomic aspects. Biomechanical studies consistently demonstrate improved rotational stability and cut-out resistance of augmented cephalomedullary fixations. Clinically, several prospective studies show a high level of technical safety and very low rates of mechanical failure. More recent cohort studies and a follow-up of a randomized trial suggest fewer cut-out events, particularly in unstable and osteoporotic fractures, but do not show a proven benefit in terms of mortality or mid-term function. From a socioeconomic perspective, cement augmentation is an effective method for achieving an overall reduction in costs in this area. Cement augmentation is not a routine procedure for every pertrochanteric fracture, but rather a selective add-on for situations with a high mechanical risk.