Alternative Fixation in Osteoporotic Fractures

Abstract

Purpose of Review

The goal of this paper is to review the current available literature in alternative fixation in osteoporotic fractures, including the roles of locking plates, polyaxial screws, bone augmentation techniques, arthroplasty, and implant coating, as well as the role of co-managed care.

Recent Findings

Bone mineral density has a definitive role in fixation failure in osteoporotic bone; in some regions, such as the femoral head, if the BMD is below 250 mg/cm³, the failure rate will increase; if these areas can be identified and the fixation strength on them improved, the failure will decrease. In order to improve the fixation strength, several strategies have been explored: locking plates, polyaxial plates and screws, augmentation of the bone with cement or bone substitutes, implant coating, and at last, the use of arthroplasty as primary treatment in severe osteoporosis and periarticular and articular fractures.

Summary

Osteoporotic fracture care continues to be a challenge, especially in fracture fixation. There has been recent improvement in the approach to these complex injuries, starting with orthogeriatric co-management models of care to improve patient care and outcomes. Additionally, surgical options have improved through advances in surgical techniques, augmentation of proximal femur and proximal humerus fractures, locking polyaxial implants, and improved coating of implants and arthroplasty.

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