As the incidence of fragility fractures increases with the ageing of the population, the primary challenge facing surgeons is how to obtain secure fixation of an implant to osteoporotic bone. Advances in implant design and surgical technique offer a means to improve outcomes of surgery.
Osteoporotic bone presents several key challenges to surgeons:
- Fractures are likely to be comminuted so making anatomical reduction more difficult.
- Osteoporosis and ageing slow fracture healing.
- Reduced cancellous bone mineral density and increased cortical porosity adversely affect the holding capacity of screws, and make internal fixation more difficult.
These issues contribute to a dramatic increase in the rate of failure of implant fixation in individuals with osteoporosis. In response to these challenges, the following major international initiatives have sought to develop best practice and broadly disseminate it to surgical teams throughout the world:
- AO Foundation Clinical Priority Program ‘Fracture Fixation in Osteoporotic Bone’. Link.
- Osteosynthesis and Trauma Care Foundation. Link.
The following reviews provide additional commentaries:
- Principles of fixation of osteoporotic fractures. J Bone Joint Surg Br. 2006 Oct;88(10):1272-1278. PubMed ID 17012413
- Surgical approach to bone healing in osteoporosis. Clin Cases Miner Bone Metab. 2009 May;6(2):131-135. PubMed ID 22461162
The linked pages below provide a summary of surgical principles relating to hip fracture and links to Cochrane reviews for surgery on hip, humerus and radius fractures. An overview of the biology of fracture healing is also provided.