Top

Current Osteoporosis Reports

Published in:

Open Access 01-12-2019 | Osteoporosis | Biomechanics (G Niebur and J Wallace, Section Editors)

Biomechanics of Osteoporotic Fracture Fixation

Authors: Marianne Hollensteiner, Sabrina Sandriesser, Emily Bliven, Christian von Rüden, Peter Augat

Published in: Current Osteoporosis Reports | Issue 6/2019

Abstract

Purpose of Review

Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures.

Recent Findings

Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems.

Summary

Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.

Osterhoff G, Morgan EF, Shefelbine SJ, Karim L, McNamara LM, Augat P. Bone mechanical properties and changes with osteoporosis. Injury. 2016;47(Suppl 2):S11–20.PubMedPubMedCentralCrossRef

Maki B, McIlroy W. Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention. Age Ageing. 2006;35:ii12–i8.PubMedCrossRef

Rubenstein L. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35:ii37–41.PubMedCrossRef

Rommens P. Paradigm shift in geriatric fracture treatment. Eur J Trauma and Emerg Surg. 2019;45(2):181–9.CrossRef

von Rüden C, Augat P. Failure of fracture fixation in osteoporotic bone. Injury. 2016;47(Suppl 2):S3–S10.CrossRef

Court-Brown C, Clement N, Duckwort A, Biant L, McQueen M. The changing epidemiology of fall-related fractures in adults. Injury. 2017;48:819–24.PubMedCrossRef

Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures: systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr. 2019;52(1):10–6.PubMedCrossRef

Wallace I, Botiguè L, Lin M, Smaers JB, Henn B, Grine F. Worldwide variation in hip fracture incidence weakly aligns with genetic divergence between populations. Osteoporos Int. 2016;27:2867–72.PubMedCrossRef

Florschutz A, Langfordn J, Haidukewych G, Koval K. Femoral neck fractures: current management. J Orthop Trauma. 2015;29(3):121–9.PubMedCrossRef

10.

Barquet A, Giannoudis P, Gelink A. Femoral neck fractures after internal fixation of trochanteric fractures with implants in situ in adults: a systematic review. Injury. 2018;49:2121–31.PubMedCrossRef

11.

Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J. 2016;98(B):291–7.PubMedCrossRef

12.

Roberts K, Brox W, Jevsevar D, Sevarino K. Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015;23:131–7.PubMedCrossRef

13.

Hannson S, Rolfson O, Akesson K, Nemes S, Leonardsson O, Rogmark C. Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patiens. Injury. 2015;46:2206–11.CrossRef

14.

Holzer G, Skrebensky G, Holzer L, Pichl W. Hip fractures and the contribution of cortical vs. trabecular bone to femoral neck strength. J Bone Miner Res. 2009;24(3):468–74.PubMedCrossRef

15.

Nawathe S, Nguyen B, Barzanian N, Akhlaghpour H, Bouxsein M, Keaveny T. Cortical and trabecular load sharing in the human femoral neck. J Biomech. 2015;48(15):816–22.PubMedCrossRef

16.

Reeve J. Role of the cortical bon in hip fracture. Bonekey Rep. 2017;6(87):1–10.

17.

Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1–S170.PubMedCrossRef

18.

Augat P, Fan B, Lane N, Lang T, LeHir P, Lu Y, et al. Assessment of bone mineral at appendicular sites in females with fractures of the proximal femur. Bone. 1998;22(4):395–402.PubMedCrossRef

19.

van Embden D, Roukema G, Rhemrev S, Genelin F, Maylaerts S. The Pauwels classification for intracapsular hip fractures: is it reliable? Injury. 2011;42(11):1238–40.PubMedCrossRef

20.

Gaspar D, Crnkovic T, Durovic D, Podsenik D, Slisuric F. AO group, AO subgroup, Garden and Pauwels classification systems of femoral neck fractures: are they reliable and reproducible? Med Glas (Zenica). 2012;9(2):243–7.PubMed

21.

Pauwels F. Der Schenkelhalsbruch: Ein mechanisches Problem. BJS. 1935;23(92):874.

22.

Reindl R, Harvex E, Berry G, Rahme E. Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures. J Bone Joint Surg. 2015;97(23):1905–12.PubMedCrossRef

23.

Queally J, Harris E, Handoll H, Parker M. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2014;12(9):CD004961.

24.

Valverde J, Alonso M, Porro J, Rueda D, Larrauri P, Soler J. Use of the gamma nail in the treatment of fractures of the proximal femur. Clin Orthop Relat Res. 1998;350:56–61.CrossRef

25.

Hoffmann S, Paetzold R, Stephan D, Püschel K, Buehren V, Augat P. Biomechanical evaluation of interlocking lag screw design in intramedullary nailing of unstable pertrochanteric fractures. J Orthop Trauma. 2013;27(9):483490.CrossRef

26.

Eberle S, Gabel J, Hungerer S, Hoffmann S, Patzold R, Augat P, et al. Auxiliary locking plate improves fracture stability and healing in intertrochanteric fractures fixated by intramedullary nail. Clin Biomech (Bristol, Avon). 2012;27(10):1006–10.CrossRef

27.

Wu D, Ren G, Peng C, Zheng X, Mao F, Zhang Y. InterTan nail versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. Diagn Pathol. 2014;9:191–6.PubMedPubMedCentralCrossRef

28.

Gueorguiev B, Lenz M. Why and how do locking plates fail? Injury. 2018;49(Suppl 1):S56–60.PubMedCrossRef

29.

Polat G, Akgül T, Ekinici M, Bayram S. A biomechanical comparison of three fixation techniques in osteoporotic reverse oblique intertrochanteric femur fracture with fragmented lateral cortex. Eur J Trauma Emerg Surg. 2019;45(3):499–505.PubMedCrossRef

30.

Streubel P, Moustoukas M, Obremsky W. Locked plating versus cephalomedullary nailing of unstable intertrochanteric femur fractures. Eur J Orthop Surg Traumatol. 2016;26(4):385–90.PubMedCrossRef

31.

Sommer C, Babst R, Muller M, Hanson B. Locking compression plate loosening and plate breakage: a report of four cases. J Orthop Trauma. 2004;18(8):571–7.PubMedCrossRef

32.

Stoffel K, Dieter U, Stachowiak G, Gachter A, Kuster MS. Biomechanical testing of the LCP—how can stability in locked internal fixators be controlled? Injury. 2003;34(Suppl 2):B11–9.PubMedCrossRef

33.

• Augat P, Bliven E, Hackl S. Biomechanics of femoral neck fractures and implications for fixation. J Orthop Trauma. 2019;33:S27–32 This article summarizes the available techniques for fracture fixation of the femoral neck and reviews them for their performance in terms of biomechanical stability. The authors emphasize the importance of load-bearing implants for unstable femoral neck fractures. PubMedCrossRef

34.

Ye Y, Hao J, Mauffrey C, Hammerberg E, Stahel P, Hak D. Optimizing stability in femoral neck fracture fixation. Orthopedics. 2015;38(10):625–30.PubMedCrossRef

35.

Lindequist S, Wredmark T, Eriksson SA, Samnegard E. Screw positions in femoral neck fractures: comparison of two different screw positions in cadavers. Acta Orthop Scand. 1993;64(1):67–70.PubMedCrossRef

36.

Kauffmann J, Simon J, Kummer F, Pearlman C, Zuckermann J, Koval K. Internal fixation of femoral neck fractures with posterior comminution: a biomechanical study. J Orthop Trauma. 1999;13(3):155–9.CrossRef

37.

Maurer S, Wright K, Kummer F, Zuckermann J, Koval K. Two or three screws for fixation of femoral neck fractures. Am J Orthop (Belle Mead NJ). 2003;32(9):438–42.PubMed

38.

Yang J, Lin L, Chao K, Chuang S, Yeh T, Lian Y. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am. 2013;95(1):61–9.PubMedCrossRef

39.

Zlowodzki M, Wijdicks C, Armitage B, Cole P. Value of washers in internal fixation of femoral neck fractures with cancellous screws: a biomechanical evaluation. J Orthop Trauma. 2015;29(2):e69–72.PubMedCrossRef

40.

Liporace F, Gaines R, Collinge C, Haidukewych G. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am. 2008;90(8):1654–9.PubMedCrossRef

41.

Deneka D, Simonian P, Stankewich C, Eckert D, Chapman J, Tencer A. Biomechanical comaprison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures. J Orthop Trauma. 1997;11(5):337–43.PubMedCrossRef

42.

Bray T. Femoral neck fracture fixation. Clinical decision making. Clin Orthop Relat Res. 1997;339:20–31.CrossRef

43.

Thein R, Herman A, Kedem P, Chechik A, Shazar N. Osteosynthesis of unstable intracapsular femoral neck fracture by dynamic locking plate or screw fixation: early results. J Orthop Trauma. 2014;28(2):70–6.PubMedCrossRef

44.

Zielinski S, Keijsers N, Praet S, Heetveld M, Bhandari M, Wilssens J, et al. Femoral neck shortening after internal fixation of a femoral neck fracture. Orthopedics. 2013;36(7):e849–e58.PubMedCrossRef

45.

Boraiah S, Paul O, Hammoud S, Gardner M, Helfet D, Lorich D. Predictable healing of femoral nech fractures treated with intraoperative compression and length-stable implants. J Trauma. 2010;69(1):142–7.PubMedCrossRef

46.

Berkens M, Little M, Lazaro L, Cymerman R, Helfet D, Lorich D. Catastrophic failure after open reduction internal fixation of femoral neck fractures with a novel locking plate implant. J Orthop Trauma. 2012;26(10):e170–e6.CrossRef

47.

Broderick JM, Bruce-Brand R, Stanley E, Mulhall KJ. Osteoporotic hip fractures: the burden of fixation failure. Sci World J. 2013;2013:515197.CrossRef

48.

Hedstrom M. Are patients with a nonunion after a femoral neck fracture more osteoporotic than others? BMD measurement before the choice of treatment?: a pilot study of hip BMD and biochemical bone markers in patients with femoral neck fractures. Acta Orthop Scand. 2004;75(1):50–2.PubMedCrossRef

49.

Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg. 2018;24(1):34–9.PubMedCrossRef

50.

Warner SJ, Garner MR, Fabricant PD, Lorich DG. Bone density correlates with clinical outcomes after ankle fracture fixation. Arch Orthop Trauma Surg. 2018;138(12):1653–7.PubMedCrossRef

51.

Lee DO, Kim JH, Yoo BC, Yoo JH. Is osteoporosis a risk factor for ankle fracture?: Comparison of bone mineral density between ankle fracture and control groups. Osteoporos Sarcopenia. 2017;3(4):192–4.PubMedPubMedCentralCrossRef

52.

• Lacombe J, Cairns BJ, Green J, Reeves GK, Beral V, MEG A, et al. The effects of age, adiposity, and physical activity on the risk of seven site-specific fractures in postmenopausal women. J Bone Miner Res. 2016;31(8):1559–68 These authors explored the role of body mass index, age, and physical activity in different fracture sites in postmenopausal women. They revealed that physical activity reduces the risk of femur fracture. Additionally, that BMI has an impact on femoral fracture risk. Specifically, that higher BMI correlates with reduced fracture risk in the femoral neck area but an increased fracture risk in the remaining femur. PubMedCrossRef

53.

Dodd AC, Lakomkin N, Attum B, Bulka C, Karhade AV, Douleh DG, et al. Predictors of adverse events for ankle fractures: an analysis of 6800 patients. J Foot Ankle Surg. 2016;55(4):762–6.PubMedCrossRef

54.

Varenne Y, Curado J, Asloum Y. Salle de Chou E, Colin F, Gouin F. Analysis of risk factors of the postoperative complications of surgical treatment of ankle fractures in the elderly: a series of 477 patients. Orthop Traumatol Surg Res. 2016;102(4 Suppl):S245–8.PubMedCrossRef

55.

Danis R. Les fractures malleolaires. In: Danis R, editor. Theorie et Pratique de l'Osteosynthese. Paris: Masson; 1949. p. 133–65.

56.

Weber B. Die Verlezungen des oberen Sprunggelenkes. 2nd ed. Verlag HansHuber: Bern; 1972.

57.

Fonseca LLD, Nunes IG, Nogueira RR, Martins GEV, Mesencio AC, Kobata SI. Reproducibility of the Lauge-Hansen, Danis-Weber, and AO classifications for ankle fractures. Rev Bras Ortop. 2018;53(1):101–6.PubMedCrossRef

58.

van Leeuwen CAT, Hoffman RPC, Donken C, van der Plaat LW, Schepers T, Hoogendoorn JM. The diagnosis and treatment of isolated type B fibular fractures: results of a nationwide survey. Injury. 2019;50(2):579–89.PubMedCrossRef

59.

Pogliacomi F, Schiavi P, Calderazzi F, Ceccarelli F, Vaienti E. When is indicated fibular fixation in extra-articular fractures of the distal tibia? Acta Biomed. 2019;89(4):558–63.PubMed

60.

Rammelt S. Management of ankle fractures in the elderly. EFORT Open Rev. 2016;1(5):239–46.PubMedPubMedCentralCrossRef

61.

Hoogervorst P, Bergen CV, Van den Bekerom M. Management of osteoporotic and neuropathic ankle fractures in the elderly. Curr Geriatr Rep. 2017;6(1):9–14.PubMedPubMedCentralCrossRef

62.

Carter TH, Duckworth AD, White TO. Medial malleolar fractures: current treatment concepts. Bone Joint J. 2019;101-B(5):512–21.PubMedCrossRef

63.

Ebraheim NA, Ludwig T, Weston JT, Carroll T, Liu J. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry. Foot Ankle Int. 2014;35(5):471–7.PubMedCrossRef

64.

Marsh JL, Saltzman CL. Ankle fractures. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green's Fractures in Adults, vol. 2. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. p. 2147–247.

65.

Bear J, Rollick N, Helfet D. Evolution in management of tibial pilon fractures. Curr Rev Musculoskelet Med. 2018;11(4):537–45.PubMedPubMedCentralCrossRef

66.

Busel GA, Watson JT. Plating of pilon fractures based on the orientation of the fibular shaft component: a biomechanical study evaluating plate stiffness in a cadaveric fracture model. J Orthop. 2017;14(2):308–12.PubMedPubMedCentralCrossRef

67.

Aneja A, Luo TD, Liu B, Domingo M, Danelson K, Halvorson JJ, et al. Anterolateral distal tibia locking plate osteosynthesis and their ability to capture OTAC3 pilon fragments. Injury. 2018;49(2):409–13.PubMedCrossRef

68.

Penny P, Swords M, Heisler J, Cien A, Sands A, Cole P. Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: is dual plate fixation necessary? Injury. 2016;47(8):1761–9.PubMedCrossRef

69.

De-Las-Heras Romero J, AML A, Sanchez FM, Garcia AP, PAG P, Sarabia RV, et al. Management of syndesmotic injuries of the ankle. EFORT Open Rev. 2017;2(9):403–9.PubMedPubMedCentralCrossRef

70.

Schnetzke M, Vetter SY, Beisemann N, Swartman B, Grutzner PA, Franke J. Management of syndesmotic injuries: what is the evidence? World J Orthop. 2016;7(11):718–25.PubMedPubMedCentralCrossRef

71.

Dingemans SA, Lodeizen OA, Goslings JC, Schepers T. Reinforced fixation of distal fibula fractures in elderly patients; a meta-analysis of biomechanical studies. Clin Biomech (Bristol, Avon). 2016;36:14–20.CrossRef

72.

Kadakia RJ, Ahearn BM, Schwartz AM, Tenenbaum S, Bariteau JT. Ankle fractures in the elderly: risks and management challenges. Orthop Res Rev. 2017;9:45–50.PubMedPubMedCentral

73.

Dabash S, Eisenstein ED, Potter E, Kusnezov N, Thabet AM, Abdelgawad AA. Unstable ankle fracture fixation using locked fibular intramedullary nail in high-risk patients. J Foot Ankle Surg. 2019;58(2):357–62.PubMedCrossRef

74.

Tas DB, Smeeing DPJ, Emmink BL, Govaert GAM, Hietbrink F, Leenen LPH, et al. Intramedullary fixation versus plate fixation of distal fibular fractures: a systematic review and meta-analysis of randomized controlled trials and observational studies. J Foot Ankle Surg. 2019;58(1):119–26.PubMedCrossRef

75.

Windolf M. Biomechanics of implant augmentation. Unfallchirurg. 2015;118(9):765–71.PubMedCrossRef

76.

Panchbhavi VK, Vallurupalli S, Morris R. Comparison of augmentation methods for internal fixation of osteoporotic ankle fractures. Foot Ankle Int. 2009;30(7):696–703.PubMedCrossRef

77.

Wallace SJ, Liskutin TE, Schiff AP, Pinzur MS. Ankle fusion following failed initial treatment of complex ankle fractures in neuropathic diabetics. Foot Ankle Surg. 2019; S1268-7731(19):30017–7.

78.

Rollmann F, Herath S, Kirchhoff F, Braun B, Holstein J, Pohlemann T, et al. Pelvic ring fractures in the elderly women now and then—a pelvic registry study. Arch Gerontol Geriatr. 2017;71:83–8.PubMedCrossRef

79.

Kannus P, Parkkari J, Niemi S, Sievönen H. Low-trauma pelvic fractures in elderly Finns in 1970-2013. Calcif Tissue Int. 2015;97(6):557–80.CrossRef

80.

Massey P, James J, Bonvillain J, Nelson B, SR M, A H. Prevalence of Low Bone Mineral Density in Younger versus older women with distal radius fractures. The American Journal of Orthopedics. 2015; 44(12):493–6.

81.

Rommens P, Wagner D, Hofmann A. Minimal invasive surgical treatment of fragility fractures of the pelvis. Chirurgie. 2017;112(5):524–37.PubMedCrossRef

82.

Andrich S, Haastert B, Neuhaus E, Neidert K, Arend W, Ohmann C, et al. Excess mortality after pelvic fractures among older people. J Bone Miner Res. 2017;32(9):1789–801.PubMedCrossRef

83.

Oberkirchner L, Ruchholtz S, Rommens P, Hofmann A, Bücking B, Krüger A. Osteoporotic pelvis fractures. Dtsch Ärztebl Int. 2018;115:70–80.

84.

Wagner D, Kamer L, Sawaguchi T, Richards G, Noser H, Rommens P. Sacral bone mass distribution assessed by averaged three-dimensional CT models. J Bone Joint Surg. 2016;98:584–90.PubMedCrossRef

85.

Culemann U, Osetern H, Pohlemann T. Aktuelle Behandlung der Beckenfraktur. Unfallchirurg. 2014;117:145–61.PubMedCrossRef

86.

Rommens P, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44:1733–44.PubMedCrossRef

87.

Zwienen C, van den Bosch E, Snijders C, Kleinrensink G, van Vugt A. Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma. 2004;18(9):589–95.PubMedCrossRef

88.

Grueneweller N, Raschke M, Zderic I, Widmer D, Waehnert D, Gueorguiev B, et al. Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model. J Orthop Res. 2017;35(7):1485–93.CrossRef

89.

Oberkircher L, Masaeli A, Bliemel C, Debus F, Ruchholtz S, Krüger A. Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens—a biomechanical investigation. Spine J. 2016;16(2):226–32.PubMedCrossRef

90.

Nicholson P, Hilditch C, Brinjiki W, Tsang A, Smith R. Single-needle lateral sacroplasty technique. Spine. 2018;40:382–5.

91.

Acklin Y, Zderic I, Buschbaum J, VArga P, Inzana H, Grechenig S, et al. Biomechanical comparison of plate and screw fixation in anterior pelvic ring fractues with low bone mineral density. Injury. 2016;47:1456–60.PubMedCrossRef

92.

Mehling I, Hessmann M, Rommens P. Stabilization of fatigue fratcures of the dorsal pelvis with a transsacral bar. Operative technique and outcome. Injury. 2012;43(4):446–51.PubMedCrossRef

93.

Schildhauer T, Ledoux W, Chapman J, Henley M, Tencer A, Routt M. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17(1):22–31.PubMedCrossRef

94.

Godinsky R, Vrabee G, Guseila L, Filipkowski D, Elias JJ. Biomechanical comparison of locked versus non-locked symphyseal plating of unstable pelvic ring injuries. Eur J Trauma Emerg Surg. 2018;44:179–84.PubMedCrossRef

95.

MacCormick L, Chen F, Gilbertson J, Khan S, Schroder L, Bechtold J, et al. A biomechanical study comparing minimally invasive anterior pelvic ring fixation techniques to external fixation. Injury. 2019;50:251–5.PubMedCrossRef

96.

Mcdonald E, Theologis A, Horst P, Kandemir U, Pekmezci M. When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study. Eur J Trauma Emerg Surg. 2015;41:665–71.PubMedCrossRef

97.

Duncan C, Masri B. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293–304.PubMed

98.

Gaski G, Scully S. Classifications in brief: Vancouver classification of postoperative periprosthetic femur fractures. Clin Orthop Relat Res. 2011;469:1507–10.PubMedCrossRef

99.

Lochab J, Carrothers A, Wong E, McLachlin S, Aldebayan W, Jenkinson R, et al. Do transcortical screws in a locking plate construct improve the stiffness in fixation of Vancouver B1 periprosthetic femur fractures? A biomechanical analysis of 2 different plating constructs. J Orthop Trauma. 2017;31:15–20.PubMedCrossRef

100.

Duncan C, Haddad F. The unified classification system (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014;96(B):713–6.PubMedCrossRef

101.

Sariyilmaz K, Korkmaz M, Özkunt O, Gemalmaz H, Sungur M, Baydogan M, et al. Comparison of fixation techniques in Vancouver type AG periprosthetic femoral fracture: a biomechanical study. Acta Orthop Traumatol Turc. 2016;50(3):373–8.PubMed

102.

McCarthy J, Bono J, Turnher R, Kremchek T, Lee J. The outcome of trochanteric reattachment in revision total hip arthroplasy with a Cable Grip System: mean 6-year followup. J Arthroplasty. 1999;14:810–4.PubMedCrossRef

103.

• Moazen M, Jones AC, Jin Z, Wilcox RK, Tsiridis E. Periprosthetic fracture fixation of the femur following total hip arthroplasty: a review of biomechanical testing. Clin Biomech. 2011;26:13–22 This study provides an overview of both the opportunities and limitations of biomechanical assessments of periprosthetic fracture treatments of the femur. Currently available computational and experimental methodologies have been explored and evaluated. CrossRef

104.

Griffiths J, Taheri A, Day R, Yates P. Better axial stiffness of a bicortical screw construct compared to a cable construct for comminuted Vancouver B1 proximal femoral fractures. J Arthroplasty. 2015;30(12):2333–7.PubMedCrossRef

105.

Lenz M, Stoffel K, Kielstein H, Mayo K, Hofmann G, Gueorguiev B. Plate fixation in periprosthetic femur fractures Vancouver type B1—trochanteric hook plate or subtrochanterical bicortical locking? Injury. 2016;47:2800–4.PubMedCrossRef

106.

Gwinner C, Märdian S, Dröge T, Schulze M, Raschke M, Stange R. Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates. Int Orthop. 2015;39(9):1749–55.PubMedCrossRef

107.

Wähnrert D, Schröder R, Schulze M, Weszerhoff P, Raschke M, Stange R. Biomechanical comparison of two angular stable plate fixation constructs for periprosthetic femur fracture fixation. Int Orthop. 2014;38:47–53.CrossRef

108.

Giesinger K, Ebneter L, Day R, Stoffel K, Yates P, Kuster M. Can plate osteosynthesis of periprosthethic femoral fractures cause cement mantle failure around a stable hip stem? A biomechanical analysis. J Arthroplasty. 2014;29:1308–12.PubMedCrossRef

109.

Konstantinidis L, Schmidt B, Bernstein A, Hiirschmüller A, Schröter S, Südkamp N, et al. Plate fixation of periprosthetic femur fractures: what happens to the cement mantle? J Eng Med. 2017;231(2):138–42.CrossRef

110.

Lenz M, Lehmann W, Wahnert D. Periprosthetic fracture fixation in osteoporotic bone. Injury. 2016;47(Suppl 2):S44–50.PubMedCrossRef

111.

Wähnert D, Grüneweller N, Gehweiler D, Brunn B, Raschke M, Stange R. Double plating in Vancouver type B1 periprosthetic proximal femur fractures: a biomechanical study. J Orthop Res. 2017;35(2):234–9.PubMedCrossRef

112.

Moazen M, Leonidou A, Pagkalos J, Marghoub A, Fagan M, Tsiridis E. Application of far cortical locking technology in periprosthetic femoral fracture fixation: a biomechanical study. J Arthroplasty. 2016;31(8):1849–56.PubMedCrossRef

113.

Gordon K, Winkler M, Hofstädter T, Dorn U, Augat P. Managing Vancouver B1 fractures by cerclage system compared to locking plate fixation—a biomechanical study. Injury. 2016;47(S2):51–7.CrossRef

Title: Biomechanics of Osteoporotic Fracture Fixation
Authors: Marianne Hollensteiner
Sabrina Sandriesser
Emily Bliven
Christian von Rüden
Peter Augat
Publication date: 01-12-2019
Publisher: Springer US
Keywords: Osteoporosis
Osteoporosis
Published in: Current Osteoporosis Reports / Issue 6/2019
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI: https://doi.org/10.1007/s11914-019-00535-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Biomechanics of Osteoporotic Fracture Fixation

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 6/2019

Exosomes and Extracellular RNA in Muscle and Bone Aging and Crosstalk

Aging and Mechanoadaptive Responsiveness of Bone

Bone Health TeleECHO: a Force Multiplier to Improve the Care of Skeletal Diseases in Underserved Communities

Effects of Diabetes on Bone Material Properties

Inflammation in Fibrodysplasia Ossificans Progressiva and Other Forms of Heterotopic Ossification

The Regulation of Marrow Fat by Vitamin D: Molecular Mechanisms and Clinical Implications