Augmentation in fragility fractures, bone of contention: a systematic review

• Published in: BMC musculoskeletal disorders Vol. 23; no. 1; pp. 1046 - 7
• Main Authors: Piccirilli, Eleonora, Cariati, Ida, Primavera, Matteo, Triolo, Rebecca, Gasbarra, Elena, Tarantino, Umberto
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02.12.2022; BioMed Central; BMC
• Subjects: Aged; Augmentation techniques; Biomechanics; Bone Density; Bone fragility; Bone mass; Calcium phosphates; Care and treatment; Complications and side effects; Elderly; Fracture healing; Fractures; Fractures, Comminuted; Fragility fractures; Humans; Humerus; Internal fixation in fractures; Literature reviews; Musculoskeletal diseases; Older people; Osteoporosis; Osteoporosis - complications; Osteoporotic Fractures - surgery; Patients; Polymethyl methacrylate; Risk factors; Surgery, Experimental; Surgical research; Systematic review; Tibia; Transplants & implants; Trauma; Italy; Osteoporosis; Bone fragility; Fragility fractures; Fracture healing; Augmentation techniques; Elderly; Augmentation strategies
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-022-06022-0

Osteoporosis is a complex multifactorial disease characterized by reduced bone mass and microarchitectural deterioration of bone tissue linked to an increase of fracture risk. Fragility fractures occur in osteoporotic subjects due to low-energy trauma. Osteoporotic patients are a challenge regarding the correct surgical planning, as it can include fixation augmentation techniques to reach a more stable anchorage of the implant, possibly lowering re-intervention rate and in-hospital stay. The PubMed database and the Google Scholar search engine were used to identify articles on all augmentation techniques and their association with fragility fractures until January 2022. In total, we selected 40 articles that included studies focusing on humerus, hip, spine, and tibia. Literature review showed a quantity of materials that can be used for reconstruction of bone defects in fragility fractures in different anatomic locations, with good results over the stability and strength of the implant anchorage, when compared to non-augmented fractures. Nowadays there are no recommendations and no consensus about the use of augmentation techniques in osteoporotic fractures. Our literature review points at implementing the use of bone augmentation techniques with a specific indication for elderly patients with comminuted fractures and poor bone quality.