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Review
. 2019 Dec;17(6):363-374.
doi: 10.1007/s11914-019-00535-9.

Biomechanics of Osteoporotic Fracture Fixation

Marianne Hollensteiner  1   2 , Sabrina Sandriesser  1   2 , Emily Bliven  1   2 , Christian von Rüden  1   2   3 , Peter Augat  4   5
Affiliations
Review

Biomechanics of Osteoporotic Fracture Fixation

Marianne Hollensteiner et al. Curr Osteoporos Rep. 2019 Dec.

Abstract

Purpose of review: Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures.

Recent findings: Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.

Keywords: Biomechanics; Bone; Fracture; Fragility fracture; Osteoporosis; Osteosynthesis.

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Conflict of interest statement

Marianne Hollensteiner, Sabrina Sandriesser, Emily Bliven, Christian von Rüden, and Peter Augat declare no conflict of interest.

Figures

Fig. 1
Fig. 1
77-year-old female with bilateral complex displaced ankle fractures (a, b) and an associated Lisfranc injury in the left foot (b). Due to vulnerable soft tissue conditions, the right ankle was fixed using open reduction and internal angle-stable plate osteosynthesis of the distal fibula, temporary ankle joint Kirschner wire fixation, and lag screw fixation of the medial malleolus (c). The complex fracture on the left required primary transarticular tibiotalocalcaneal nailing (d)
Fig. 2
Fig. 2
78-year-old male following fall from an apple tree resulting in a comminuted acetabular fracture with displaced quadrilateral plate and acetabular dome also involving the anterior column (a). The fracture was fixated using a small fragment plate and cortical screws. An additional medial infrapectineal small fragment plate was placed to stabilize the displaced quadrilateral plate (b)
Fig. 3
Fig. 3
Displaced periprosthetic femur fracture below the tip of the cemented arthroplasty stem (Vancouver type C) in a 90-year-old female treated by open reduction and internal fixation using two cerclages and a locking plate system
See this image and copyright information in PMC

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