Injury | International Journal of the Care of the Injured - Volume 47 - Supplement 2

Editorial

Osteoporotic fracture fixation

–

a biomechanical perspective

Bone tissue changes with age and most of these changes become

accentuated with osteoporosis. If the age associated alterations in

bone tissue exceed a significant threshold, it may qualify for being

osteoporotic. Thus the effects of age and osteoporosis on bone become

indistinguishable, both leading to a steadily increasing number of

fragility fractures. The burden of illness for these fragility fractures is

immense, frequently leading to hospitalization, long term nursing

home care, musculoskeletal disabilities and death [1

–

3]. Orthopaedic

surgeons are typically the first who are confronted with patients after a

fragility fracture. Although the treatment of patients with fragility

fractures requires a holistic approach, the major problem of their

management continues to be how to achieve optimum fracture fixation

allowing early mobilization and promoting a successful bone repair

response [4,5].

Fragility fractures are more challenging to treat compared to

fractures in otherwise healthy bone. Although most orthopaedic

surgeons would agree with this statement, there is little evidence to

scientifically support it. More importantly there is only limited

consensus on possible explanations why fractures in osteoporotic

patients constitute a challenge and how this should be addressed.

Strategies to improve outcome of patients after fragility fractures

currently address biological and biomechanical perspectives. However,

the available evidence how fragility fractures are effectively treated

is sparse and relies mostly on basic and pre-clinical research. Transfer

of this evidence into clinical decision making is difficult for the

individual being either a scientist or a clinician, rarely both. Thus,

finding a consensus for the adequate treatment for fragility fractures

remains a challenge.

The Orthopaedic Trauma Care (OTC) Foundation is a global net-

work of scientists and surgeons, dedicated to the advancement of

osteosynthesis and trauma care. Their members have identified

fragility fractures as one of the current burning issue in trauma

care which requires mutual discussions among scientists and clini-

cians alike. They have decided to discuss the two most important

perspectives on the treatment of fragility fractures

–

biological and

biomechanical

–

in two expert workshops. While the results of the first

workshop

“

Osteoporotic fractures

–

the biological perspective

”

have

been published [6], the current volume is based on a workshop held in

Boston, MA in November 2014 entitled

“

Osteoporotic fractures

–

the

biomechanical perspective.

”

The current volume will not only summarize the available evidence

from basic research for the treatment of fragility fractures but will

also put this information into a clinical perspective. All the manu-

scripts included are authored by scientists and surgeons and focus

on finding a consensus to the benefit of the patient with a fragility

fracture. The first series of manuscripts addresses the biomechanical

properties of aged and osteoporotic bone. They describe the local and

global changes that occur in bone with aging and osteoporosis and

also explain the clinically relevant differences inmechanical properties

between trabecular and cortical bone tissue. Although a large

armamentarium of radiological equipment is available for the quanti-

fication of bone mineral it often remains vague how this will affect

fixation stability during surgery. Thus, it will be addressed what

determines the fixation stability in fragile bone and how this can be

practically evaluated. The last topic in this first series illustrates the

biomechanical considerations of fracture fixation in fragile bone and

how failure of fracture fixation can be explained and also hopefully

avoided.

The second series of manuscripts describes why healing of

osteoporotic fractures appears to be different from healing in normal

bone and how this can be employed to develop improved strategies

for the management of osteoporotic fractures. Among these strategies

for the management of fragility fractures, the use of bone augmen-

tation became very popular and will be discussed in a separate

manuscript. With increased activity levels of elderly individuals,

fractures of osteoporotic bone also occur after traumatic events with

significant mechanical impact [7]. These fractures sometime lead to

bone defects which require bone void fillers. As it is currently unclear

which are the most successful materials for this purpose a manuscript

on the development of these materials has also been included.

The last series of manuscripts reviews methods for the fixation of

fractures around prostheses. Patients with periprosthetic fractures

often have advanced age and present with many comorbidities

–

situation which requires immediate mobilization. Approaches to

provide sufficient stabilization vary greatly and will be reviewed in

two manuscripts.

Injury, Int. J. Care Injured 47S2 (2016) S1

–

Contents lists available at ScienceDirect

Injury

journal homepage: www.

elsevier.com/locate/Injury