Biomechanical Considerations in Osteoporotic Fracture Fixation

Abstract

Background: Osteoporotic Fractures (OF) present formidable but predictable challenges in fixation. With ageing the bone mineral density is reduced and the internal micro-architecture is disrupted. This increases fracture risk and makes implant hold tenuous. Newer implant technology has helped improve fracture fixation but the risks of early mechanical failure remain tangible.

Purpose: After fracture reduction and fixation, the surgeon remains apprehensive regarding rehabilitation. The concerns are higher in the lower limb where non-weight bearing is not possible. Understanding basic mechanics and translating that knowledge to fracture surgery helps provide secure surgical stability to enable full weight bearing assisted mobilization.

Conclusion: Applying the logic of mechanics to living biological tissue will help the surgeon better understand the unique mechanical requirements of the fractured bone. Judicious surgical technique and careful combination of implants balancing the mechanical and biological needs of the ageing broken bone will help it heal. Integrating technology and surgical technique with the established principles of osteosynthesis will help improve functional outcomes in OF.

Keywords: Area moment of inertia; Biomechanics; Bone mineral density; Microarchitecture; Osteoporosis; Stainless steel; Titanium.