Alternative Fixation in Osteoporotic Fractures
- 98 Downloads
Purpose of Review
The goal of this paper is to review the current available literature in alternative fixation in osteoporotic fractures, including the roles of locking plates, polyaxial screws, bone augmentation techniques, arthroplasty, and implant coating, as well as the role of co-managed care.
Bone mineral density has a definitive role in fixation failure in osteoporotic bone; in some regions, such as the femoral head, if the BMD is below 250 mg/cm3, the failure rate will increase; if these areas can be identified and the fixation strength on them improved, the failure will decrease. In order to improve the fixation strength, several strategies have been explored: locking plates, polyaxial plates and screws, augmentation of the bone with cement or bone substitutes, implant coating, and at last, the use of arthroplasty as primary treatment in severe osteoporosis and periarticular and articular fractures.
Osteoporotic fracture care continues to be a challenge, especially in fracture fixation. There has been recent improvement in the approach to these complex injuries, starting with orthogeriatric co-management models of care to improve patient care and outcomes. Additionally, surgical options have improved through advances in surgical techniques, augmentation of proximal femur and proximal humerus fractures, locking polyaxial implants, and improved coating of implants and arthroplasty.
KeywordsOsteoporosis Fragility fractures Fracture fixation Implant augmentation Orthogeriatrics
Compliance with Ethical Standards
Conflict of Interest
Daniela Tafur reports grants from OTA, outside the submitted work.
Carlos Olarte reports payment as a speaker from DPS and Lilly and an international grant for research from OTA.
David Cabrera, Julian Salavarrieta, and Rodrigo Fernando Pesantez declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 2.•• Kammerlander C, Neuerburg C, Verlaan J-J, Schmoelz W, Miclau T, Larsson S. The use of augmentation techniques in osteoporotic fracture fixation. Injury. 2016;47(Suppl 2):S36–43. This is a great review of the current techniques for fracture augmentation in osteoporotic bone. CrossRefGoogle Scholar
- 7.•• Konstantinidis L, Helwig P, Hirschmüller A, Langenmair E, Südkamp NP, Augat P. When is the stability of a fracture fixation limited by osteoporotic bone? Injury. 2016;47(Suppl 2):S27–32. Looks for the threshold value for bone quality beyond which the risk of fracture fixation failure increases, in intertrochanteric fractures it is 250 mg/cm3. CrossRefGoogle Scholar
- 48.Ahmed M, Durcan L, O’Beirne J, Quinlan J, Pillay I. Fracture liaison service in a non-regional orthopaedic clinic—a cost-effective service. Ir Med J. 2012;105(24):26–7.Google Scholar