Outcomes of cement augmentation in fragility trochanteric hip fractures - A multicenter randomized controlled trial follow-up.

PURPOSE: Cement augmentation is considered to improve the bone-implant construct stability in hip fragility fractures, additionally biomechanical studies show that cement augmentation improves the pull-out strength and increases resistance to failure. Thus far, the advantage of these technique used in a clinical scenario is yet to be determined METHODS: a randomized, multicenter, single-blinded clinical trial was conducted in patients aged 65 years or older who were admitted to two level I trauma centers with a fragility intertrochanteric hip fracture during September 2015 and December 2017. Patients were stratified into 2 groups: patients between 65 and 85 years and older than 85 years. A balanced block randomization was performed using blocks of 6 patients: 3 patients assigned to the control group (no augmentation) and 3 patients to the intervention group. Follow-up visits were done at 1, 3, 6 and 12 postoperative months documenting the tip-apex distance (TAD) as well as followed up after 5 to 7 years of surgical procedure documenting EQ5D, Parker Mobility Score and mortality rates at these different time points. RESULTS: A total of 90 patients were included but only 53 patients completed a one-year follow up. The mean immediate postoperative and one-year follow up TAD measurement from the whole cohort (20.99 mm vs 21.3 mm, respectively) showed no statistical significance (P = 0.18). For patients in the control group, the difference of TAD measurements from the immediate postoperative and one-year follow-up was -0.25 mm (P = 0.441). For patients included in the intervention group, the difference of TAD measurement from the immediate postoperative and 1-year follow up was -0.48 mm (P = 0.383). No statistical difference was found when stratified by age (p = 0.78). One patient from the control group had an implant failure after 1-month postoperative. Readmission after 30 days showed no statistical difference between both groups (7 vs. 7 patients, p = 0.754). Augmentation did not show a difference in most of the functional outcomes nor quality of life after 5 to 7 years of surgical procedure. CONCLUSIONS: The use of augmentation can be considered a safe procedure for the fixation of fragility hip fractures.

Impact of a Secondary Prevention Program for Fragility Fractures at the Orthogeriatric Clinical Care Center at the Fundación Santa Fe de Bogotá, 2014-2020.

Introduction: The presence of a fragility fracture increases the risk of new fractures. The timely and prompt initiation of treatment for osteoporosis can reduce the incidence of new fractures, for which adherence to management is a determining factor. The main objective of the study was to characterize the secondary prevention program for fragility hip fractures in patients older than 65 years, determine adherence to treatment and its effect on the appearance of new fractures in the established follow-up period. Materials and Methods: A descriptive retrospective cohort study was carried out. Patients older than 65 years with a fragility hip fracture treated by an Orthogeriatric Clinical Care Center between May 2014 and April 2020 who completed a one-year follow-up were included. Results: A final sample of 290 patients was obtained (226 women and 64 men) with an average age of 82.27 years. It was found that 84.5% of patients received indications to start osteoporotic management prior to hospital discharge and only 35.2% started the treatment in the first 6 postoperative months. 16.6% (n = 48) of patients presented a new fracture, with no significant difference between those who started their osteoporosis treatment in a timely manner. Out of the 48 patients, 5 patients (10.4%) met therapeutic failure criteria. Discussion: Most patients (84.5%) received indications for starting osteoporotic treatment before hospital discharge, nevertheless 35.2% started it during the first 6 postoperative months. 16.6% of patients presented a new fracture during follow up, of which only five met therapeutic failure criteria. Conclusions: No significant differences were found between the presence of new fractures and early initiation of osteoporotic management. However, literature shows that prompt and timely osteoporotic treatment reduces the incidence of new fractures, thus measures must be implemented to strengthen the adherence and surveillance of patients to the indicated treatment.