Surgical treatment of osteoporotic fractures: An update on the principles of management

Yaacobi, Eyal; Sánchez, Daniela; Maniar, Hemil; Horwitz, Daniel S.

doi:10.1016/j.injury.2017.08.036

Cited by 44 publications

(51 citation statements)

References 49 publications

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“…The positive effect of percutaneous approaches on perioperative complications has been described previously, therefore we are using a minimally invasive approach [41,49,50]. Similar to the therapy of osteoporotic fractures in other regions of the body, the use of angular stable implants has significant potential to result in higher stability and pullout forces than conventional implants [51][52][53][54]. In our data, we did not see any complication regarding implant failure, even though we only managed to get hold of follow-up X-ray examinations in 32 out of 53 patients.…”

Section: Discussionmentioning

confidence: 94%

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Schmerwitz¹,

Jungebluth²,

Lehmann³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Fragility fractures of the pelvis (FFP) are common in older patients. We evaluated the clinical outcome of using a minimally invasive posterior locked compression plate (MIPLCP) as therapeutic alternative. Methods 53 Patients with insufficiency fractures of the posterior pelvic ring were treated with MIPLCP when suffering from persistent pain and immobility under conservative treatment. After initial X-ray, CT-scans of the pelvis were performed. In some cases an MRI was also performed to detect occult fractures. Postoperatively patients underwent conventional X-ray controls. Data were retrospectively analyzed for surgical and radiation time, complication rate, clinical outcome and compared to the literature. Results Patients (average age 79.1 years) underwent surgery with operation time of 52.3 min (SD 13.9), intra-operative X-ray time of 9.42 s (SD 9.6), mean dose length product of 70.1 mGycm (SD 57.9) and a mean hospital stay of 21.2 days (SD 7.7). 13% patients (n = 7) showed surgery-related complications, such as wound infection, prolonged wound secretion, irritation of the sacral root or clinically inapparent screw malpositioning. 17% (n = 9) showed postoperative complications (one patient died due to pneumonia 24 days after surgery, eight patients developed urinal tract infections). 42 patients managed to return to previous living situation. 34 were followed-up after a mean period of 31.5 (6–90) months and pain level at post-hospital examination of 2.4 (VAS) with an IOWA Pelvic Score of 85.6 (55–99). Conclusion We showed that MIPLCP osteosynthesis is a safe surgical alternative in patients with FFP 3 and FFP 4. This treatment is another way of maintaining a high level of stability in the osteoporotic pelvic ring with a relatively low complication rate, low radiation and moderate operation time and a good functional outcome.

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Section: Discussionmentioning

confidence: 94%

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Schmerwitz¹,

Jungebluth²,

Lehmann³

et al. 2020

Eur J Trauma Emerg Surg

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“…Osteoporosis is a prevailing metabolic bone disease in both men > 50 years and postmenopausal women, which increases bone fragility and may further result in bone fractures, thus significantly leading to serious health problems for patients ( 1 ). Worldwide, nearly 200 million people are diagnosed with osteoporosis annually, even leading to almost 9 million osteoporotic fractures ( 2 ). In the US, it was approximately 53.6 million of the adult population of years > 50 who suffered from osteoporosis and low bone mass (54% of the population) ( 3 ).…”

Section: Introductionsmentioning

confidence: 99%

Osteoimmunology: The Regulatory Roles of T Lymphocytes in Osteoporosis

et al. 2020

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Immune imbalance caused bone loss. Osteoimmunology is emerging as a new interdisciplinary field to explore the shared molecules and interactions between the skeletal and immune systems. In particular, T lymphocytes (T cells) play pivotal roles in the regulation of bone health. However, the roles and mechanisms of T cells in the treatment of osteoporosis are not fully understood. The present review aims to summarize the essential regulatory roles of T cells in the pathophysiology of various cases of osteoporosis and the development of T cell therapy for osteoporosis from osteoimmunology perspective. As T cell-mediated immunomodulation inhibition reduced bone loss, there is an increasing interest in T cell therapy in an attempt to treat osteoporosis. In summary, the T cell therapy may be further pursued as an immunomodulatory strategy for the treatment of osteoporosis, which can provide a novel perspective for drug development in the future.

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“…2 Osteoporosis is a prevailing skeletal disease of the elderly; nearly 200 million osteoporotic patients are diagnosed annually, and almost 9 million osteoporotic fractures occur worldwide. 3 Surgery is the primary treatment strategy for osteoporotic fracture; however, poor prognoses are presented due to the combination of biological and surgical factors. 4 The common sites of osteoporotic bones are usually compromised and comminuted, which makes it hard to achieve an optimum reduction and stable fixation.…”

Section: Introductionmentioning

confidence: 99%

“…4 The common sites of osteoporotic bones are usually compromised and comminuted, which makes it hard to achieve an optimum reduction and stable fixation. 3,5 Osteoporotic fractures occur mostly in elderly patients, who exhibit underlying, unfavorable systemic conditions that are prone to complications. 6 The abnormal remodeling status of bone with osteoporosis would deteriorate after bed braking, which poses a disadvantage with respect to fracture healing and bone callus strength; furthermore, the refracture risk following surgery increases significantly.…”

Section: Introductionmentioning

confidence: 99%

Bench-to-bedside strategies for osteoporotic fracture: From osteoimmunology to mechanosensation

et al. 2019

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Osteoporosis is characterized by a decrease in bone mass and strength, rendering people prone to osteoporotic fractures caused by low-energy forces. The primary treatment strategy for osteoporotic fractures is surgery; however, the compromised and comminuted bones in osteoporotic fracture sites are not conducive to optimum reduction and rigid fixation. In addition, these patients always exhibit accompanying aging-related disorders, including high inflammatory status, decreased mechanical loading and abnormal skeletal metabolism, which are disadvantages for fracture healing around sites that have undergone orthopedic procedures. Since the incidence of osteoporosis is expected to increase worldwide, orthopedic surgeons should pay more attention to comprehensive strategies for improving the poor prognosis of osteoporotic fractures. Herein, we highlight the molecular basis of osteoimmunology and bone mechanosensation in different healing phases of elderly osteoporotic fractures, guiding perioperative management to alleviate the unfavorable effects of insufficient mechanical loading, high inflammatory levels and pathogen infection. The well-informed pharmacologic and surgical intervention, including treatment with anti-inflammatory drugs and sufficient application of antibiotics, as well as bench-to-bedside strategies for bone augmentation and hardware selection, should be made according to a comprehensive understanding of bone biomechanical properties in addition to the remodeling status of osteoporotic bones, which is necessary for creating proper biological and mechanical environments for bone union and remodeling. Multidisciplinary collaboration will facilitate the improvement of overall osteoporotic care and reduction of secondary fracture incidence.

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Surgical treatment of osteoporotic fractures: An update on the principles of management

Cited by 44 publications

References 49 publications

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Osteoimmunology: The Regulatory Roles of T Lymphocytes in Osteoporosis

Bench-to-bedside strategies for osteoporotic fracture: From osteoimmunology to mechanosensation

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