Mechanical evaluation of fracture fixation augmented with tricalcium phosphate bone cement in a porous osteoporotic cancellous bone model

Cory Collinge*, Bradley Merk, Eugene P. Lautenschlager

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


OBJECTIVE: The purpose of this study was to examine the effects of resorbable bone cement on screw and plate-screw fracture fixation in a porous osteoporotic bone model. METHODS: Experiment 1: Screw pullout strength was assessed for 4 sets of 4.5-mm cortical screws inserted into a synthetic osteoporotic cancellous bone model, including screws inserted without cement augmentation (control), screws augmented with tricalcium phosphate (TCP) bone cement (Norian SRS; Synthes USA, Paoli, PA), and screws augmented with polymethylmethacrylate. Experiment 2: The effects of cement augmentation on plate-screw fixation strength were examined by performing cantilever bending tests on 4 sets of 8 plate-screw constructions, including nonaugmented and TCP-augmented standard and locked screw-plate constructions in a similar bone model. RESULTS: Experiment 1: Cement augmentation with both TCP and polymethylmethacrylate increased screw pullout strength from a porous osteoporotic cancellous bone model by about 4-fold (P < 0.05), and there was no significant difference between the 2 cements (P > 0.1). Experiment 2: Fixation strength was 1.5 times higher for locked plates compared with standard plates when neither was augmented with cement (P = 0.07). Cement augmentation with TCP improved fixation strength by 3.6 times for a standard plate-screw construction (P < 0.05) and 3.3 times for a locked plate-screw construction (P < 0.05). The most stable construction was the TCP-augmented locked plate, in which a 5-fold increase was observed compared with that of standard plates without TCP (P < 0.05). CONCLUSIONS: This study indicates augmenting screws with TCP cement during osteosynthesis improves fixation strength in an osteoporotic cancellous bone model. CLINICAL RELEVANCE: In fracture situations in which osteoporotic bone makes screw and screw-plate fixation tenuous, screw augmentation with TCP cement should be considered as adjunct treatment.

Original languageEnglish (US)
Pages (from-to)124-128
Number of pages5
JournalJournal of orthopaedic trauma
Issue number2
StatePublished - Feb 1 2007


  • Bone cement
  • Fracture fixation
  • Locked plating
  • Osteoporotic fixation
  • Resorbable cement
  • Screw augmentation
  • Screw pullout
  • Tricalcium phosphate cement

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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