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Is It Necessary to Use Cement Augmentation in Internal Fixation for Trochanteric Fractures in the Elderly? A
Adhe Sugandhi1, Ni Kadek Saras Dwi Guna1, Grace Yulia Alphani Yapson1
1General Practitioner, Universitas Udayana, Denpasar, Bali, Indonesia.
Objective:
To evaluate the efficacy of cement augmentation in internal fixation of trochanteric fractures in the elderly.
Methods:
A comprehensive search of the MEDLINE, SpringerLink, CENTRAL, and Scopus databases was conducted up to February 2025 for randomized clinical trials (RCTs) comparing internal fixation with and without cement augmentation. The review adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Random-effects models were used to pool effect estimates. The primary outcomes were fixation failure and tip-apex distance (TAD). The secondary outcomes included mortality, reoperation rate, length of hospital stay, blood loss, and operative time. The risk of bias was assessed with the revised version of the Cochrane Risk of Bias tool (RoB 2.0; Cochrane Collaboration), and evidence certainty, with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Results:
Five RCTs comprising 509 patients were included. Cement augmentation did not significantly reduce fixation failure (relative risk [RR] = 1.13; 95%CI: 0.20-6.43) but significantly improved the TAD (mean difference [MD] = -2.11 mm; 95%CI: -3.13 to -1.09; p < 0.0001). There were no significant effects on mortality (RR = 1.10; 95%CI: 0.54-2.22) or reoperation (RR = 0.12; 95%CI: 0.01-2.09). Cement augmentation shortened the hospital stay by 2.5 days (MD = -2.59; 95%CI: -6.87 to 1.69), but it increased blood loss (MD = 49.01; 95%CI: -61.78 to 159.8) and operative time by 11 minutes (MD = 11.8; 95%CI: 5.91-17.69).
Conclusions:
Cement augmentation improves fixation quality and reduces hospitalization in elderly patients with trochanteric fractures, but it increases blood loss and operative time. Its use should be individualized based on patient risk profiles.
