In vivo, there are many factors that influence the stability of a bone/cement interface including lavage, bone density, hemostasis, the cement application technique, the consistency of the cement, and the heat created during cement application (Askew et al. 1984, Benjamin et al. 1987, Bannister and Miles 1988, Breusch and Malchau 2005, Bitsch et al. 2010, 2011, Aro et al. 2012).
This method seems to be more appropriate since micro-defects may form during the process of cement application and curing, and as a result of subsequent cyclic loadings in routine activities.
First-step biomechanical trials performed by Upasani et al. [ 27] comparing the titanium mesh cages with cement application and the commonly used balloon kyphoplasty showed significant greater height maintenance and significant less cement amounts in the titanium mesh group.
This technique includes a cement application under the tibial base plate and around the tibial stem.
Another problem following cement application is the changed biomechanical behavior (increased stiffness) of the vertebral body which in turn promotes other complications as adjacent fracture development [ 5, 6, 21– 23, 41].
Second step biomechanical studies by Ghofrani et al. [ 21] compared the titanium mesh cages without cement application versus kyphoplasty in human spine cadavers and revealed similar results.
One single third step studies showed that VCF stabilization combining cement application and the titanium mesh cages are effective in terms of fracture reduction with low complication rates in a clinical setting [ 14].
We recorded demographic variables, dates of admission and surgery, types of fracture, medical comorbidities, medications used, type of implant used, seniority levels of the operating surgeon and the anesthetist, hemodynamic status immediately before and after cement application and in recovery, and time and cause of death.
For both treatment strategies, kypho- and vertebroplasty, procedural disadvantages as incomplete fracture reduction or loss of the restored height in the time frame between reduction with balloon deflation and cement application are reported [ 13, 25, 26].
Before cement application, suction was applied through a vent on the femur at the level of the lesser trochanter.
Cardiovascular events such as desaturation on cement application or hypotension may happen in the operating theater, leading to fatalities in exceptional cases [ 82, 83].
