Current options to surgical treatment in osteoporotic fractures

Marongiu, Giuseppe; Mastio, Michele; Capone, Antonio

doi:10.1007/s40520-013-0081-2

Cited by 19 publications

(17 citation statements)

References 20 publications

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“…Even though periprosthetic fractures are not included in the current definition of AFs, available data indicate that there may be similar underlying pathology. Therefore, treatment includes both surgical than pharmacological therapy (20). In unstable acetabular components, with uncontained cavitary defect and severe bone loss revision surgery is mandatory, but there might be likely an important role of anabolic drugs in promoting fracture healing.…”

Section: @ C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Atypical periprosthetic acetabular fracture in long-term alendronate therapy

Marongiu

Capone

2016

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SummaryBisphosphonates have been commonly used in the treatment of osteoporosis, demonstrating its efficacy in fracture risk reduction. However, even if are generally safe and well tolerated, concerns have emerged about atypical fractures related to its prolonged use. Although atypical femoral fracture are more common, case reports demonstrated that even other skeletal areas can be involved by unusual pattern of fracture. We report a atypical acetabular periprosthetic fracture in a 83-year-old female patient after prolonged alendronate treatment for osteoporosis and isolated acetabular revision surgery. The patient underwent to clinical, bioumoral and radiological evaluation and all the history cases were fully reported. We believe this periprosthetic fracture, according to the available data, may have similar underlying pathology to atypical femoral fractures. Awareness of symptoms, in addition to a regular radiographic survey may facilitate early diagnosis and possible prevention of spontaneous periprosthetic fractures, in patients receiving bisphosphonate therapy beyond 5 years. The treatment of this atypical periprosthetic fracture should include both surgical than pharmacological therapy to obtained bone healing.

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Section: @ C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Atypical periprosthetic acetabular fracture in long-term alendronate therapy

Marongiu

Capone

2016

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“…Zhen reported 100% of union after plating and vascularized fibular osteo-septocutaneous flap graft for complex tibial shaft complex fractures; however, 10 out 38 experimented donor-site morbidities [17]. Moreover, bone grafting represents an additional option in all the osteoporosis related and so-called fragility fractures [10]. Limitations of ABG extensive use are the limited availability, graft dimension and donor site morbidity (i.e., iliac crest or fibula) [18].…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacological interventions that could modulate the healing process positively have been recently merged to the treatment algorithm, where systemic anti-osteoporosis drugs are considered the additional contributing factor [8]. The role of systemic drug therapies in long bones fracture healing remains limited, although the use several anabolic agents has reported positive results in selected shaft fractures types, such as atypical femoral fractures, periprosthetic femoral fractures and recalcitrant non-unions [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

et al. 2020

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Background: The healing of long bones diaphyseal fractures can be often impaired and eventually end into delayed union and non-union. A number of therapeutic strategies have been proposed in combination with surgical treatment in order to enhance the healing process, such as scaffolds, growth factors, cell therapies and systemic pharmacological treatments. Our aim was to investigate the current evidence of bone healing enhancement of acute long bone diaphyseal fractures. Methods: A systematic review was conducted by using Pubmed/MEDLINE; Embase and Ovid databases. The combination of the search terms “long-bones; diaphyseal fracture; bone healing; growth factors; cell therapies; scaffolds; graft; bone substitutes; orthobiologics; teriparatide”. Results: The initial search resulted in 4156 articles of which 37 papers fulfilled the inclusion criteria and were the subject of this review. The studies included 1350 patients (837 males and 513 females) with a mean age of 65.3 years old. Conclusions: General lack of high-quality studies exists on the use of adjuvant strategies for bone healing enhancement in acute shaft fractures. Strong evidence supports the use of bone grafts, while only moderate evidence demineralized bone matrix and synthetic ceramics. Conflicting results partially supported the use of growth factors and cell therapies in acute fractures. Teriparatide showed promising results, particularly for atypical femoral fractures and periprosthetic femoral fractures.

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“…Given that advanced imaging modalities have not been shown to improve interobserver agreement, we compared the three classification systems using only x-rays. Nevertheless, CT scans and 3D reconstruction play a crucial role Marongiu et al J Orthop Traumatol (2020) 21:4 for valuable comprehension of the fracture and to plan a surgical approach in more complex cases [33]. Torrens et al found that addition of 3D imaging of proximal humeral fractures significantly increased the number of surgical decisions when compared with radiographs alone or together with CT [34].…”

Section: Discussionmentioning

confidence: 99%

Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: a comparison of three different classification systems

et al. 2020

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Background: The classification systems for proximal humeral fractures routinely used in clinical practice include the Neer and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 2007 systems. Currently used systems have low inter-and intraobserver reliability. In 2018, AO/OTA introduced a new classification system with the aim of simplifying the coding process, in which the Neer four-part classification was integrated into the fracture description. The aim of the present work is to assess the inter-and intraobserver agreement of the new AO/OTA 2018 compared with the Neer and AO/OTA 2007 classifications. Materials and methods: A total of 116 radiographs of consecutive patients with proximal humeral fracture were selected and classified by three observers with different levels of experience. All three observers independently reviewed and classified the images according to the Neer, AO/OTA 2007, and new AO/OTA 2018 systems. To determine the intraobserver agreement, the observers reviewed the same set of radiographs after an interval of 8 weeks. The inter-and intraobserver agreement were determined through Cohen's kappa coefficient analysis. Results: The new AO/OTA 2018 classification showed substantial mean inter-(k = 0.67) and intraobserver (k = 0.75) agreement. These results are similar to the reliability observed for the Neer classification (interobserver, k = 0.67; intraobserver, k = 0.85) but better than those found for the AO/OTA 2007 system, which showed only moderate inter-(k = 0.57) and intraobserver (k = 0.58) agreement. The two more experienced observers showed better overall agreement, but no statistically significant difference was found. No differences were found between surgical experience and agreement regarding specific fracture types or groups. Conclusions: The results showed that the Neer system still represents the more reliable and reproducible classification. However, the new AO/OTA 2018 classification improved the agreement among observers compared with the AO/OTA 2007 system, while still maintaining substantial descriptive power and simplifying the coding process. The universal modifiers and qualifications, despite their possible complexity, allowed a more comprehensive fracture definition without negatively affecting the reliability or reproducibility of the classification system.

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Current options to surgical treatment in osteoporotic fractures

Cited by 19 publications

References 20 publications

Atypical periprosthetic acetabular fracture in long-term alendronate therapy

Atypical periprosthetic acetabular fracture in long-term alendronate therapy

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: a comparison of three different classification systems

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