A presentation about osteoporotic bone fractures, risk factors, epidemiology, approach to patient with these fractures and their management.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Principles of fixation of osteoporotic
fractures
Presented by :
Dr. Mohammed Abdul-wahab
Unit :
Mr.Mohammed Babiker Mr.khalid Zurrog
Mr .wagas Idress Ms. Lina Abbas

2. Objectives:
 to have an idea about:
• the epidemiology of osteoporosis
• Pathophysiology of osteoporosis
• Approach to patient with osteoporotic fractures
• surgical strategy
• Surgical techniques

3. introduction
• Despite advances in the prevention and treatment of
osteoporotic fractures, their prevalence continues to
increase.
• Globally, approximately 200 million people are at risk of
sustaining an osteoporotic fracture each year.

4. • the increasing number of patients expected to
experience osteoporotic fractures, the so-called “silver
tsunami,” is already being sensed by orthopaedic
surgeons and others who provide care to elderly
patients.

6. pathophysiology
In osteoporosis , there is a decrease in bone density and
quality,Thinner cross-linking connections within trabecular
bone.and endosteal diaphyseal resorption and medullary
expansion.

7. • Results in :
• - changes in the bending and torsional characteristics of
the entire bone and predispose to low-energy fractures.
• - decrease the anchorage of fixation devices
(screws,nails,stems )
As example :
A decrease by 1 mm of cortical thickness results in a
decrease in screw holding power by 50%.

9. • The healing of a fracture in osteoporotic bone passes
through the normal stages and concludes with union of
the fracture although the healing process is prolonged.

10. approach to a patient with
osteoporotic bone fracture
• As any trauma patient follow ATLS protocol .
• After the patient being stabilized ,take a detailed history
exposing patient
• - co-morbidities
• -risk factors for osteoporosis
• - functional level and expected outcome from
management.

11. • -examination
• -relevant investigation
• -imaging
• - finally a well planned surgery .

12. Our goal
• - to have a secure fracture fixation that allows early
weight bearing and mobilization before complications
takes place.(bed sores,DVT,loss of function,etc)

13. Surgical strategy
• Depends on :
• 1- patient’s characteristics
• 2- type of fracture and location
• 3- soft tissue envelope preservation
• 4-understanding the biomechanical factors affecting
osteoporotic fracture fixation.

14. • The critical point in fracture fixation in osteoporotic bone
is the bone-implant interface.
• the problem :
The load in bone-implant interface > the strain
tolerance in osteoporotic bone.

15. • That’s why this result in :
Micro-fractures, resorption of the bone then loosening of
the implant >>> failure
• Which is often a bone failure rather than implant failure
(breakage).
• Solution :
Using load sharing devices with large contact area
distributing the load .

17. Surgical techniques
• 1- use of relative stability techniques such as
intramedullary nails. Why ?
• because it reduce the stress at the bone-implant
interface.

18. • 2-buttress/anti-glide fixation
• Also avoid high strain at single screw and provide large
contact area at bone- implant interface
• for meta-physeal fractures

19. • 3- fixed-angle devices i.e locked plates (LCP)
useful as they resist angular deformation and torsion.
- Further more the holding power of implant can be
increased by multiple angle locking screws.(PHILOS plate)

20. The major difference between locking and conventional plate constructs is the way load
is transferred between the implant and fracture fragments.

21. • 4-bone impaction
reduces the risk of implant failure before bony union
has occurred.
as in Gamma nail and DHS .

22. • 5-bone augmentation:
using variety of choices
bone auto-graft
bone allograft
bone cement(PMMA)
Bone substitutes (ca phosphate,ca suphate,HA..etc)

25. • 6-Joint replacement :
another option for osteoporotic patients with articular
fractures, and some metaphyseal fractures, where internal
fixation is inappropriate or the patient has pre-existing
arthritis

28. Thank you..