Cic edizioni internazionali
Clinical Cases in mineral and bone metabolism

Surgical strategies for high-energy fractures in patients with osteoporosis

Mini-Review, 60 - 65
doi: 10.11138/ccmbm/2018.15.1.060
Tag this article
Abstract
Full text PDF
The most obvious clinical pattern of osteoporosis is represented by the so-called low energy fractures. These are slight trauma bone lesions that would not occur in a subject with normal bone mineral density (BMD). The most frequently affected sites of this type of fracture are the last dorsal and lumbar vertebrae, the proximal femur, humerus, and the distal radius.
These fractures are a challenge for the orthopedic surgeons because they occur on an altered bone, with decreased load resistance, reduced elasticity and decreased ability to absorb mechanical stresses. This physio-pathological pattern results in lower stability of the hardware, lower screws purchase, less resistance to bone-prosthesis interface, lower quality of the healing process.
The problem becomes more complex when high-energy trauma occur in osteoporotic bone with fractures in nontypical locations such as distal femur, tibial plate, tibial malleolus, elbow or peri-phrostetic fractures after Total Knee or Hip Replacement.
The surgical approach to these fractures aims to use devices that assure greater bone-implant stability and a great distribution of stresses by reducing the forces acting on the bone-implant interface.
It is possible to use scaffolds such as bioactive cement and porous coating surfaces to increase the hardware purchase and homologous / autologous transplantation, post-operative pharmacological implementation and growth factors to stimulate potential repair of fractures.
The use of locking plates allows converting the sliding forces, which the traditional plates generated, into compression forces to increase the stability of the system. There are also versatile hardware with dynamic angular stability screws that can be freely oriented in space unlike conventional plates where the direction of the screw is dictated by the placement of the plate.
The philosophy of minimal invasive surgery is well represented by the use of intramedullary nails, which can stabilize the fracture from the inside of the bone marrow.
This characteristic ensures a load distribution within the bone especially in meta-diaphysis areas, which are most affected by typical reduction of bone quality of osteoporosis. In the elderly, the total joint replacement is also indicated in cases of peri-articular fractures in which there is a high risk of bone fragments necrosis. Such fractures can be treated with a prosthetic implant to ensure immediate joint stability and thus allow an early recovery of the range of motion and the function of the affected limb.
Treatment of peri-prosthetic fractures is another important chapter in surgery of traumatic fractures in osteoporosis as we find more and more frequent patients who have a prosthetic implant and who undergo a trauma that causes a peri-implant fracture. In this case, the evaluation of the implant’s stability to the bone-prosthesis interface is crucial to decide whether to perform a synthesis with angular stability, nails and/or cerclage wires, or to perform a revision. In all cases, treatment of traumatic fractures in osteoporosis requires a multidimensional evaluation of the problem, as it is not only the type of fracture and site that can be considered, but also the bone quality by carefully evaluating the patient’s functional and metabolic state and its comorbidity. It is a surgery that requires specific implants and devices that must be carried out by experienced hands.

Vol. XV (No. 3) 2018 September - December

  1. From the Editor-in-Chief
    Brandi M.L.
  2. Effect on Trabecular Bone Score (TBS) of Tissue-Selective Estrogen Complex (TSEC) in early post-menopausal women: case report
    Lello S., Capozzi A., Scambia G.
  3. Sport and physical activity in patients with hereditary multiple exostoses
    D'Ambrosi R., Caldarini C., Massari G., Facchini R.M., Ragone V.
  4. Underdiagnosis of osteoporosis in different ethnic groups when bone mineral density is measured in a single area
    Mastaglia S.R., Bagur A., Mautalen C.A.
  5. Approach in aromatase inhibitors - induced osteoporosis: results from an Italian multicenter observational study
    Migliaccio S., de Sire A., Marocci C., Fornari R., Paoletta M., Greco E.A., Amar I.D., Moretti A., Ronzoni S., Gimigliano F., Vinicola V., Chiacchiararelli F., Guadalascara F., Pastore R., Falaschi P., Minisola G., Falla O., Castellitto D., Lenzi A., Villa P., Iolascon G.
  6. The clinical safety and possibility of immediate implant placement in aggressive periodontitis patients in maxillary esthetic zone: an empty systematic review
    Yussif N.M., Rahman A.R.A., Darhous M.
  7. Bilateral atypical femoral fractures in macroprolactinoma with hypopituitarism: a case report
    Charoensri S., Pongchaiyakul C.
  8. Spinal deformities in neurofibromatosis type 1
    Lykissas M.G., Mavrogenis A.F., Megaloikonomos P.D., Gelalis I.D., Lykomitros V.
  9. Treatment of osteoarthritis: focus on glucosamine
    Rovati L.C.
  10. Refractory hypercalcemia after idiopathic rhabdomyolysis
    Rodríguez-Quintero J.H., Ramos-Pineda A., Salas-Villela R., Gotés-Palazuelos J.
  11. Severe scoliosis in a Colombian patient with childhood hypophosphatasia
    Zarante Bahamón A.M.
  12. Teriparatide in cervical fracture consolidation
    Cordeiro Albino C., Porcelli Savarani C., Aguiar Moreira C.
  13. Incidental finding of osteopetrosis complicated with osteomyelitis
    Ibrahim A.K., Sansare K., Karjodkar F.R:
  14. Hungry bone syndrome presenting as pathological fracture in a young boy
    Chandra A., Hussain Z., Prasad Assat R., Chandra Meena R.
  15. Rare multifocal eosinophilic granuloma involving maxilla and mandible. A case report
    Shawky Shaker I., Salah Mohamed N.
  16. Teriparatide treatment for an atypical femoral fracture in a patient with calcinosis cutis associated with juvenile dermatomyositis: a case report
    Yoshitani J., Kabata T., Yamamoto N., Shimizu M., Kajino Y, Takagi T., Ohmori T., Ueno T., Tsuchiya H.
  17. Surgical approach to rare case of recurrent pheochromocytoma and bones metastatic paraganglioma
    Cosseddu F., Sacchetti F., Shytaj S., Grossi S., Citarelli C., De Gori M., D'Arienzo A., Capanna R.
  18. Mazabraud’s syndrome: a case report
    Ramírez Stieben R. S., Lifton S.
  19. A case of hypercalcemic parathyroid crisis in a patient with normocalcemic hyperparathyroidism
    Lithgow K., Pasieka J., Kline G.
  20. A Platelet Rich Plasma (PRP) and bovine xenograft combination placed in a jaw bone defect after surgical removal of a compound odontoma associated with an impacted lower canine using piezoelectric surgery: a case report
    Ayoub Al-Delayme R.M.
  21. Pharmacological therapy of sarcopenia: past, present and future
    Iolascon G., Moretti A., de Sire A., Liguori S., Toro G., Gimigliano F.
  22. Revision surgery for acetabular nonunion: role and challenges to preservation of hip joint
    Rollò G., Meccariello L., Bisaccia M., Pichierri P., Filipponi M., Giaracuni M., Di Giacomo L.M., Zinghì G.
  23. Reliability and value of external modular fixation (Hoffmann II®) in the management of humeral shaft fracture
    Bisaccia M., Meccariello L., Rinonapoli G., Ibáñez-Vicente C., Ribes-Iborra J., Gomez-Garrido D., Rollo G., Falzarano G., Shahid Khan M., Grubor P., Caraffa A.
Last Viewed articles: la lista degli ultimi x visitati.
  1. Surgical strategies for high-energy fractures in patients with osteoporosis
    Cozzi Lepri A., Capone A., Del Prete A., Soderi S., Soderi S., Muncibì F., Innocenti M.
    doi: 10.11138/ccmbm/2018.15.1.060
credits