Biologics in Hip Fracture Surgery

Femoral Neck Fracture

Femoral neck fractures are increasingly common in the aging population, often requiring surgical fixation. Trochanteric fracture repair is challenging in osteoporotic bone, where poor density weakens screw anchorage and raises the risk of cut-out and fixation failure.

Augmentation With Biologic Bone Substitutes

Augmentation of trochanteric nail with biological bone substitutes aims to improve implant stability, reduce complications, and enable early mobilization.

Significantly improved fixation with biologic augmentation compared to control^2,5-7

Calcium phosphate cement provides overall positive clinical and biomechanical outcomes.

Augmentation With Biologic Bone Substitutes

Scientific Insights

Five studies, including 2 RCTs, show calcium phosphate cement can improve fixation stability, reduce postoperative pain, support bone integration, and limit leakage.

Radiological and biomechanical assessments highlight the benefits of biologic augmentation in improving fixation and overall surgical outcomes.

Enhanced Fixation Stability
CP augmentation significantly improves implant anchorage compared to nonaugmented controls^2,5-7
Reduced Postoperative Pain
Patients experience meaningful pain relief with CP augmentation⁷
Promoted Bone Integration
CP supports restoration of natural bone architecture⁴
Minimized Cement Leakage
Lower risk of extravasation, remaining confined within bone defects¹

References

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Key Takeaways

CP augmentation improves fixation in osteoporotic bone and reduces cut-out risk⁶
PMMA provides immediate mechanical strength but lacks biological integration
CP cement offers a promising alternative which is osteoconductive and provides overall positive clinical and biomechanical outcomes

Study Limitations

Few high-level studies on biologic augmentation
Small sample sizes and heterogeneous designs
No standardized protocols for CP cement use in trochanteric nails

Augmentation With Biologic Bone Substitutes

References

Park JY, Kim TK, Cho BW, Kwon HM, Park KK, Lee WS. Comparison of mechanical and clinical outcomes between cement-augmented and conventional cephalomedullary nailing in osteoporotic trochanteric fractures: A propensity score-matched cohort study. BMC Musculoskelet Disord. 2025;26(1):1010. doi: 10.1186/s12891-025-09249-9
Stramazzo L, Ratano S, Monachino F, Pavan D, Rovere G, Camarda L. Cement augmentation for trochanteric fracture in elderly: A systematic review. J Clin Orthop Trauma. 2020;15:65-70. doi:10.1016/j.jcot.2020.10.034
Dall’Oca C, Maluta T, Moscolo A, Lavini F, Bartolozzi P. Cement augmentation of intertrochanteric fractures stabilised with intramedullary nailing. Injury. 2010;41(11):1150-1155. doi:10.1016/j.injury.2010.09.026
Lindner T, Kanakaris NK, Marx B, Cockbain A, Kontakis G, Giannoudis PV. Fractures of the hip and osteoporosis: The role of bone substitutes. J Bone Joint Surg Br. 2009;91(3):294-303. doi:10.1302/0301-620X.91B3.21273
Usami T, Takada N, Iwata H, Sakai H, Hattori Y, Sekiya I, Ueki Y, Nagaya Y, Murakami H, Kuroyanagi G. A biomechanical analysis of the effect of hydroxyapatite augmentation for trochanteric femoral fractures. Exp Ther Med. 2023 ;25(6):256. doi:10.3892/etm.2023.11955
Kim SJ, Park HS, Lee DW, Lee JW. Is calcium phosphate augmentation a viable option for osteoporotic hip fractures?. Osteoporos Int. 2018;29(9):2021-2028. doi:10.1007/s00198-018-4572-z
Mattsson P, Larsson S. Unstable trochanteric fractures augmented with calcium phosphate cement. A prospective randomized study using radiostereometry to measure fracture stability. Scand J Surg. 2004;93(3):223-228. doi:10.1177/145749690409300310
Mattsson P, Alberts A, Dahlberg G, Sohlman M, Hyldahl HC, Larsson S. Resorbable cement for the augmentation of internally-fixed unstable trochanteric fractures. A prospective, randomised multicentre study. J Bone Joint Surg Br. 2005;87(9):1203- 1209. doi:10.1302/0301-620X.87B9.15792