Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies
Background: Different augmentation techniques have been described in the literature in addition to the surgical treatment of proximal humeral fractures. The aim of this systematic review was to analyze the use of cements, bone substitutes, and other devices for the augmentation of proximal humeral f...
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MDPI AG
2020-05-01
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| Series: | Journal of Functional Biomaterials |
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| Online Access: | https://www.mdpi.com/2079-4983/11/2/29 |
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| author | Giuseppe Marongiu Marco Verona Gaia Cardoni Antonio Capone |
| author_facet | Giuseppe Marongiu Marco Verona Gaia Cardoni Antonio Capone |
| author_sort | Giuseppe Marongiu |
| collection | DOAJ |
| description | Background: Different augmentation techniques have been described in the literature in addition to the surgical treatment of proximal humeral fractures. The aim of this systematic review was to analyze the use of cements, bone substitutes, and other devices for the augmentation of proximal humeral fractures. Methods: A systematic review was conducted by using PubMed/MEDLINE, ISI Web of Knowledge, Cochrane Library, Scopus/EMBASE, and Google Scholar databases according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines over the years 1966 to 2019. The search term “humeral fracture proximal” was combined with “augmentation”; “polymethylmethacrylate, PMMA”; “cement”; “bone substitutes”; “hydroxyapatite”; “calcium phosphates”; “calcium sulfate”; “cell therapies”, and “tissue engineering” to find the literature relevant to the topic under review. Results: A total of 10 clinical studies considered eligible for the review, with a total of 308 patients, were included. Mean age at the time of injury was 68.8 years (range of 58–92). The most commonly described techniques were reinforcing the screw–bone interface with bone PMMA cement (three studies), filling the metaphyseal void with synthetic bone substitutes (five studies), and enhancing structural support with metallic devices (two studies). Conclusion: PMMA cementation could improve screw-tip fixation. Calcium phosphate and calcium sulfate injectable composites provided good biocompatibility, osteoconductivity, and lower mechanical failure rate when compared to non-augmented fractures. Mechanical devices currently have a limited role. However, the available evidence is provided mainly by level III to IV studies, and none of the proposed techniques have been sufficiently studied. |
| first_indexed | 2024-03-10T20:01:16Z |
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| institution | Directory Open Access Journal |
| issn | 2079-4983 |
| language | English |
| last_indexed | 2024-03-10T20:01:16Z |
| publishDate | 2020-05-01 |
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| record_format | Article |
| series | Journal of Functional Biomaterials |
| spelling | doaj.art-5f8e785fd3ec4b0b986651d4fb809a312023-11-19T23:31:04ZengMDPI AGJournal of Functional Biomaterials2079-49832020-05-011122910.3390/jfb11020029Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical StudiesGiuseppe Marongiu0Marco Verona1Gaia Cardoni2Antonio Capone3Orthopedic and Trauma Clinic, Department of Surgical Sciences, Cagliari State University, 09126 Cagliari, ItalyOrthopedic and Trauma Clinic, Department of Surgical Sciences, Cagliari State University, 09126 Cagliari, ItalyOrthopedic and Trauma Clinic, Department of Surgical Sciences, Cagliari State University, 09126 Cagliari, ItalyOrthopedic and Trauma Clinic, Department of Surgical Sciences, Cagliari State University, 09126 Cagliari, ItalyBackground: Different augmentation techniques have been described in the literature in addition to the surgical treatment of proximal humeral fractures. The aim of this systematic review was to analyze the use of cements, bone substitutes, and other devices for the augmentation of proximal humeral fractures. Methods: A systematic review was conducted by using PubMed/MEDLINE, ISI Web of Knowledge, Cochrane Library, Scopus/EMBASE, and Google Scholar databases according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines over the years 1966 to 2019. The search term “humeral fracture proximal” was combined with “augmentation”; “polymethylmethacrylate, PMMA”; “cement”; “bone substitutes”; “hydroxyapatite”; “calcium phosphates”; “calcium sulfate”; “cell therapies”, and “tissue engineering” to find the literature relevant to the topic under review. Results: A total of 10 clinical studies considered eligible for the review, with a total of 308 patients, were included. Mean age at the time of injury was 68.8 years (range of 58–92). The most commonly described techniques were reinforcing the screw–bone interface with bone PMMA cement (three studies), filling the metaphyseal void with synthetic bone substitutes (five studies), and enhancing structural support with metallic devices (two studies). Conclusion: PMMA cementation could improve screw-tip fixation. Calcium phosphate and calcium sulfate injectable composites provided good biocompatibility, osteoconductivity, and lower mechanical failure rate when compared to non-augmented fractures. Mechanical devices currently have a limited role. However, the available evidence is provided mainly by level III to IV studies, and none of the proposed techniques have been sufficiently studied.https://www.mdpi.com/2079-4983/11/2/29proximal humeral fractureaugmentationbone substitutescementpolymethylmethacrylatePMMA |
| spellingShingle | Giuseppe Marongiu Marco Verona Gaia Cardoni Antonio Capone Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies Journal of Functional Biomaterials proximal humeral fracture augmentation bone substitutes cement polymethylmethacrylate PMMA |
| title | Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies |
| title_full | Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies |
| title_fullStr | Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies |
| title_full_unstemmed | Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies |
| title_short | Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies |
| title_sort | synthetic bone substitutes and mechanical devices for the augmentation of osteoporotic proximal humeral fractures a systematic review of clinical studies |
| topic | proximal humeral fracture augmentation bone substitutes cement polymethylmethacrylate PMMA |
| url | https://www.mdpi.com/2079-4983/11/2/29 |
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