{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:17:01Z","timestamp":1792898221581,"version":"4.5.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T00:00:00Z","timestamp":1623715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (&gt;65 years) following low energy trauma.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>PubMed\/Medline\/Embase\/CENTRAL\/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. Subgroup analysis was performed stratified by study design (RCTs and observational studies). The primary outcome is overall complication rate. Secondary outcomes include re-operation rate, mortality, operation duration, hospital stay, general quality of life, radiologic measures and functional hip scores.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of four RCT\u2019s (437 patients) and three observational studies (293 patients) were included. The effect estimates of RCTs were equal to those obtained from observational studies. Cement augmentation has a significantly lower overall complication rate (28.3% versus 47.2%) with an odds ratio (OR) of 0.3 (95%CI 0.1\u20130.7). The occurrence of device\/fracture related complications was the largest contributing factor to this higher overall complication rate in the non-augmented group (19.9% versus 6.0%, OR 0.2, 95%CI 0.1\u20130.6). Cement augmentation also carries a lower risk for re-interventions (OR 0.2, 95%CI 0.1\u20130.7) and shortens the hospital stay with 2 days (95%CI -2.2 to -0.5 days). The mean operation time was 7 minutes longer in the augmented group (95%CI 1.3\u201312.9). Radiological scores (lag screw\/blade sliding mean difference -3.1mm, 95%CI -4.6 to -1.7, varus deviation mean difference -6.15\u00b0, 95%CI; -7.4 to -4.9) and functional scores (standardized mean difference 0.31, 95%CI 0.0\u20130.6) were in favor of cement augmentation. Mortality was equal in both groups (OR 0.7, 95%CI 0.4\u20131.3) and cement related complications were rare.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Cement augmentation in fixation of trochanteric femoral fractures leads to fewer complications, re-operations and shorter hospital stay at the expense of a slightly longer operation duration. Cementation related complications occur rarely and mortality is equal between treatment groups. Based on these results, cement augmentation should be considered for trochanteric fractures in elderly patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0251894","type":"journal-article","created":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T17:25:46Z","timestamp":1623777946000},"page":"e0251894","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":34,"title":["Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0257-1654","authenticated-orcid":true,"given":"Ingmar F.","family":"Rompen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Knobe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjoern-Christian","family":"Link","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J. P.","family":"Beeres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Baumgaertner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Diwersi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Migliorini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Nebelung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reto","family":"Babst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J. M.","family":"van de Wall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,6,15]]},"reference":[{"issue":"1","key":"pone.0251894.ref001","first-page":"1","article-title":"Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: Data from the Swedish fracture register 11 Medical and Health Sciences 1103 Clinical Sciences 11 Medical and Health Sciences 1117 Public Health and Health Services","volume":"19","author":"L Mattisson","year":"2018","journal-title":"BMC Musculoskelet Disord."},{"issue":"4","key":"pone.0251894.ref002","doi-asserted-by":"crossref","first-page":"700","DOI":"10.2106\/JBJS.G.00517","article-title":"Nail or plate fixation of intertrochanteric hip fractures: Changing pattern of practice\u2014A review of the American Board of Orthopaedic Surgery database","volume":"90","author":"JO Anglen","year":"2008","journal-title":"J Bone Jt Surg\u2014Ser A"},{"issue":"9","key":"pone.0251894.ref003","doi-asserted-by":"crossref","first-page":"2831","DOI":"10.1007\/s11999-013-2834-9","article-title":"Unstable intertrochanteric femur fractures: is there a consensus on definition and treatment in Germany?","volume":"471","author":"M Knobe","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"9","key":"pone.0251894.ref004","first-page":"CD000093","article-title":"Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults","author":"MJ Parker","year":"2010","journal-title":"Cochrane database Syst Rev."},{"issue":"5\u20136","key":"pone.0251894.ref005","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/S0020-1383(97)00035-1","article-title":"Failure of femoral head fixation: a cadaveric analysis of lag screw cut-out with the gamma locking nail and AO dynamic hip screw","volume":"28","author":"RC Haynes","year":"1997","journal-title":"Injury"},{"issue":"5","key":"pone.0251894.ref006","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1002\/jor.21236","article-title":"Hip screw migration testing: first results for hip screws and helical blades utilizing a new oscillating test method","volume":"29","author":"CT Born","year":"2011","journal-title":"J Orthop Res Off Publ Orthop Res Soc"},{"issue":"5","key":"pone.0251894.ref007","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1302\/0301-620X.93B5.25539","article-title":"Dynamic hip screw versus DHS blade: a biomechanical comparison of the fixation achieved by each implant in bone","volume":"93","author":"F O\u2019Neill","year":"2011","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0251894.ref008","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/1471-2474-12-79","article-title":"Is the rotation of the femoral head a potential initiation for cutting out? A theoretical and experimental approach.","volume":"12","author":"A Lenich","year":"2011","journal-title":"BMC Musculoskelet Disord."},{"issue":"2","key":"pone.0251894.ref009","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s00264-017-3587-y","article-title":"Screw-blade fixation systems in Pauwels three femoral neck fractures: a biomechanical evaluation","volume":"42","author":"M Knobe","year":"2018","journal-title":"Int Orthop."},{"issue":"1","key":"pone.0251894.ref010","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.clinbiomech.2011.07.006","article-title":"Biomechanical evaluation of bone-cement augmented Proximal Femoral Nail Antirotation blades in a polyurethane foam model with low density","volume":"27","author":"A Sermon","year":"2012","journal-title":"Clin Biomech (Bristol, Avon)"},{"issue":"6","key":"pone.0251894.ref011","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.injury.2013.03.003","article-title":"Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures\u2014a biomechanical cadaver study","volume":"44","author":"F Fensky","year":"2013","journal-title":"Injury"},{"issue":"8","key":"pone.0251894.ref012","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1016\/j.injury.2018.04.022","article-title":"Cement augmentation of the Proximal Femoral Nail Antirotation (PFNA)\u2013A multicentre randomized controlled trial","volume":"49","author":"C Kammerlander","year":"2018","journal-title":"Injury"},{"issue":"9","key":"pone.0251894.ref013","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1007\/s00198-018-4572-z","article-title":"Is calcium phosphate augmentation a viable option for osteoporotic hip fractures?","volume":"29","author":"S-J Kim","year":"2018","journal-title":"Osteoporos Int"},{"key":"pone.0251894.ref014","doi-asserted-by":"crossref","first-page":"215145932091212","DOI":"10.1177\/2151459320912121","article-title":"Predicting Factors for Return to Prefracture Ambulatory Level in High Surgical Risk Elderly Patients Sustained Intertrochanteric Fracture and Treated With Proximal Femoral Nail Antirotation (PFNA) With and Without Cement Augmentation","volume":"11","author":"N Kulachote","year":"2020","journal-title":"Geriatr Orthop Surg Rehabil."},{"key":"pone.0251894.ref015","first-page":"223","article-title":"UNSTABLE TROCHANTERIC FRACTURES AUGMENTED WITH CALCIUM PHOSPHATE CEMENT","author":"P Mattsson","year":"2004","journal-title":"A prospective randomized study using radiostereometry to measure fracture stability"},{"issue":"15","key":"pone.0251894.ref016","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of Observational Studies in EpidemiologyA Proposal for Reporting","volume":"283","author":"DF Stroup","year":"2000","journal-title":"JAMA"},{"issue":"5","key":"pone.0251894.ref017","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"8","author":"D Moher","year":"2010","journal-title":"Int J Surg"},{"key":"pone.0251894.ref018","article-title":"ORIF versus MIPO for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies","author":"FJP Beeres","year":"2021","journal-title":"Injury"},{"key":"pone.0251894.ref019","article-title":"MIPO versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies","author":"BJM van de Wall","year":"2021","journal-title":"Eur J trauma Emerg Surg Off Publ Eur Trauma Soc"},{"issue":"7","key":"pone.0251894.ref020","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1016\/j.jse.2020.01.072","article-title":"Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies","volume":"29","author":"BJM van de Wall","year":"2020","journal-title":"J shoulder Elb Surg."},{"issue":"1","key":"pone.0251894.ref021","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and Dislocation Classification Compendium-2018","volume":"32","author":"EG Meinberg","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"9","key":"pone.0251894.ref022","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (minors): development and validation of a new instrument","volume":"73","author":"K Slim","year":"2003","journal-title":"ANZ J Surg"},{"issue":"8","key":"pone.0251894.ref023","article-title":"Central Head Perforation, or \u201cCut Through,\u201d Caused by the Helical Blade of the Proximal Femoral Nail Antirotation.","volume":"26","author":"H-C Frei","year":"2012","journal-title":"J Orthop Trauma"},{"key":"pone.0251894.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2474-14-1","article-title":"Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures.","volume":"14","author":"AJ Bojan","year":"2013","journal-title":"BMC Musculoskelet Disord"},{"issue":"2","key":"pone.0251894.ref025","doi-asserted-by":"crossref","first-page":"240","DOI":"10.4103\/0259-1162.94796","article-title":"Bone cement implantation syndrome: A rare catastrophe","volume":"5","author":"N Mudgalkar","year":"2011","journal-title":"Anesth essays Res"},{"key":"pone.0251894.ref026","article-title":"Cementation: for better or worse? Interim results of a multi-centre cohort study using a fenestrated spiral blade cephalomedullary device for pertrochanteric fractures in the elderly","author":"DKH Yee","year":"2020","journal-title":"Arch Orthop Trauma Surg"},{"issue":"4","key":"pone.0251894.ref027","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1097\/TA.0b013e3181c995ec","article-title":"Dynamic Hip Screws for Unstable Intertrochanteric Fractures in Elderly Patients\u2014Encouraging Results With a Cement Augmentation Technique","volume":"68","author":"Po-Cheng MD Lee","year":"2010","journal-title":"J Trauma Inj Infect Crit Care"},{"issue":"11","key":"pone.0251894.ref028","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.injury.2010.09.026","article-title":"Cement augmentation of intertrochanteric fractures stabilised with intramedullary nailing","volume":"41","author":"C Dall\u2019Oca","year":"2010","journal-title":"Injury"},{"issue":"4","key":"pone.0251894.ref029","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00402-012-1677-2","article-title":"Absorbable and non-absorbable cement augmentation in fixation of intertrochanteric femur fractures: Systematic review of the literature","volume":"133","author":"S Namdari","year":"2013","journal-title":"Arch Orthop Trauma Surg"},{"issue":"6","key":"pone.0251894.ref030","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1007\/s00198-016-3484-z","article-title":"Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study","volume":"27","author":"PTPW Burgers","year":"2016","journal-title":"Osteoporos Int"},{"issue":"4","key":"pone.0251894.ref031","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s00068-018-1020-x","article-title":"Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis","volume":"45","author":"RB Beks","year":"2019","journal-title":"Eur J trauma Emerg Surg Off Publ Eur Trauma Soc"},{"key":"pone.0251894.ref032","doi-asserted-by":"crossref","first-page":"k5120","DOI":"10.1136\/bmj.k5120","article-title":"Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis","volume":"364","author":"Y Ochen","year":"2019","journal-title":"BMJ"},{"issue":"4","key":"pone.0251894.ref033","doi-asserted-by":"crossref","first-page":"e203497","DOI":"10.1001\/jamanetworkopen.2020.3497","article-title":"Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults: A Systematic Review and Meta-analysis","volume":"3","author":"Y Ochen","year":"2020","journal-title":"JAMA Netw open"},{"issue":"8","key":"pone.0251894.ref034","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1177\/0363546516673615","article-title":"Surgical Versus Nonsurgical Treatment for Midshaft Clavicle Fractures in Patients Aged 16 Years and Older: A Systematic Review, Meta-analysis, and Comparison of Randomized Controlled Trials and Observational Studies","volume":"45","author":"DPJ Smeeing","year":"2017","journal-title":"Am J Sports Med."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251894","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T17:26:39Z","timestamp":1623777999000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0251894"}},"subtitle":[],"editor":[{"given":"Hans-Peter","family":"Simmen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,15]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0251894","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,15]]}}}