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Erschienen in: Current Osteoporosis Reports 1/2015

01.02.2015 | Orthopedic Management of Fractures (D Little and T Miclau, Section Editors)

Internal Fixation of Osteoporotic Fractures

verfasst von: David L. Rothberg, Mark A. Lee

Erschienen in: Current Osteoporosis Reports | Ausgabe 1/2015

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Abstract

Osteoporosis leads to bone fragility and increased risk of fracture. Despite advances in diagnosis and treatment, the prevalence continues to rise. Osteoporotic fracture treatment has a unique set of difficulties related to poor bone quality and traditional approaches, and implants may not perform well. Fixation failure and repeat surgery are poorly tolerated and highly undesirable in this patient population. This review illustrates the most recent updates in internal fixation, implant design, and surgical theory regarding treatment of patients with osteoporotic fractures.
Literatur
1.
Zurück zum Zitat Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2006;22:465–75.CrossRef Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2006;22:465–75.CrossRef
2.
Zurück zum Zitat Looker AC, Orwoll ES, Johnston CC, Lindsay RL, Wahner HW, Dunn WL, et al. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. 1997;12:1761–8.PubMedCrossRef Looker AC, Orwoll ES, Johnston CC, Lindsay RL, Wahner HW, Dunn WL, et al. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. 1997;12:1761–8.PubMedCrossRef
3.
Zurück zum Zitat Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–50.PubMedCrossRef Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–50.PubMedCrossRef
4.
Zurück zum Zitat U.S. Dept. of Health and Human Services. Bone health and osteoporosis: a report of the Surgeon General. Rockville, Md: Public Health Service, Office of the Surgeon General. Washington, D.C.: U.S. G.P.O. 2004;1-436. U.S. Dept. of Health and Human Services. Bone health and osteoporosis: a report of the Surgeon General. Rockville, Md: Public Health Service, Office of the Surgeon General. Washington, D.C.: U.S. G.P.O. 2004;1-436.
5.
Zurück zum Zitat Koehne T, Vettorazzi E, Küsters N, Lüneburg R, Kahl-Nieke B, Püschel K, et al. Trends in trabecular architecture and bone mineral density distribution in 152 individuals aged 30-90 years. Bone. 2014;66:31–8.PubMedCrossRef Koehne T, Vettorazzi E, Küsters N, Lüneburg R, Kahl-Nieke B, Püschel K, et al. Trends in trabecular architecture and bone mineral density distribution in 152 individuals aged 30-90 years. Bone. 2014;66:31–8.PubMedCrossRef
6.
Zurück zum Zitat Willett K, Hearn TC, Cuncins AV. Biomechanical testing of a new design for Schanz pedicle screws. J Orthop Trauma. 1993;7:375–80.PubMedCrossRef Willett K, Hearn TC, Cuncins AV. Biomechanical testing of a new design for Schanz pedicle screws. J Orthop Trauma. 1993;7:375–80.PubMedCrossRef
7.
Zurück zum Zitat Kido HW, Bossini PS, Tim CR, Parizotto NA, da Cunha AF, Malavazi I, et al. Evaluation of the bone healing process in an experimental tibial bone defect model in ovariectomized rats. Aging Clin Exp Res. 2014. Kido HW, Bossini PS, Tim CR, Parizotto NA, da Cunha AF, Malavazi I, et al. Evaluation of the bone healing process in an experimental tibial bone defect model in ovariectomized rats. Aging Clin Exp Res. 2014.
8.
Zurück zum Zitat Giannoudis P, Tzioupis C, Almalki T, Buckley R. Fracture healing in osteoporotic fractures: is it really different? Injury. 2007;38:S90–9.PubMedCrossRef Giannoudis P, Tzioupis C, Almalki T, Buckley R. Fracture healing in osteoporotic fractures: is it really different? Injury. 2007;38:S90–9.PubMedCrossRef
9.
Zurück zum Zitat Nikolaou VS, Efstathopoulos N, Kontakis G, Kanakaris NK, Giannoudis PV. The influence of osteoporosis in femoral fracture healing time. Injury. 2009;40:663–8.PubMedCrossRef Nikolaou VS, Efstathopoulos N, Kontakis G, Kanakaris NK, Giannoudis PV. The influence of osteoporosis in femoral fracture healing time. Injury. 2009;40:663–8.PubMedCrossRef
10.
Zurück zum Zitat Turner IG, Rice GN. Comparison of bone screw holding strength in healthy bovine and osteoporotic human cancellous bone. Clin Mater. 1992;9:105–7.PubMedCrossRef Turner IG, Rice GN. Comparison of bone screw holding strength in healthy bovine and osteoporotic human cancellous bone. Clin Mater. 1992;9:105–7.PubMedCrossRef
11.
Zurück zum Zitat Sanders R, Haidukewych GJ, Milne T, Dennis J, Latta LL. Minimal versus maximal plate fixation techniques of the ulna: the biomechanical effect of number of screws and plate length. J Orthop Trauma. 2002;16:166–71.PubMedCrossRef Sanders R, Haidukewych GJ, Milne T, Dennis J, Latta LL. Minimal versus maximal plate fixation techniques of the ulna: the biomechanical effect of number of screws and plate length. J Orthop Trauma. 2002;16:166–71.PubMedCrossRef
12.
Zurück zum Zitat Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18:488–93.PubMedCrossRef Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18:488–93.PubMedCrossRef
13.
Zurück zum Zitat Cordey J, Borgeaud M, Perren SM. Force transfer between the plate and the bone: relative importance of the bending stiffness of the screws friction between plate and bone. Injury. 2000;31 Suppl 3:C21–8.PubMedCrossRef Cordey J, Borgeaud M, Perren SM. Force transfer between the plate and the bone: relative importance of the bending stiffness of the screws friction between plate and bone. Injury. 2000;31 Suppl 3:C21–8.PubMedCrossRef
14.
Zurück zum Zitat Bottlang M, Doornink J, Lujan TJ, Fitzpatrick DC, Marsh JL, Augat P, et al. Effects of construct stiffness on healing of fractures stabilized with locking plates. J Bone Joint Surg. 2010;92 Suppl 2:12–22.PubMedCentralPubMedCrossRef Bottlang M, Doornink J, Lujan TJ, Fitzpatrick DC, Marsh JL, Augat P, et al. Effects of construct stiffness on healing of fractures stabilized with locking plates. J Bone Joint Surg. 2010;92 Suppl 2:12–22.PubMedCentralPubMedCrossRef
15.
Zurück zum Zitat Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the locking compression plate (LCP). Injury. 2003;34 Suppl 2:B43–54.PubMedCrossRef Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the locking compression plate (LCP). Injury. 2003;34 Suppl 2:B43–54.PubMedCrossRef
16.
Zurück zum Zitat Bottlang M, Doornink J, Byrd GD, Fitzpatrick DC, Madey SM. A nonlocking end screw can decrease fracture risk caused by locked plating in the osteoporotic diaphysis. J Bone Joint Surg. 2009;91:620–7.PubMedCrossRef Bottlang M, Doornink J, Byrd GD, Fitzpatrick DC, Madey SM. A nonlocking end screw can decrease fracture risk caused by locked plating in the osteoporotic diaphysis. J Bone Joint Surg. 2009;91:620–7.PubMedCrossRef
17.
Zurück zum Zitat O’Toole RV, Andersen RC, Vesnovsky O, Alexander M, Topoleski LDT, Nascone JW, et al. Are locking screws advantageous with plate fixation of humeral shaft fractures? A biomechanical analysis of synthetic and cadaveric bone. J Orthop Trauma. 2008;22:709–15.PubMedCrossRef O’Toole RV, Andersen RC, Vesnovsky O, Alexander M, Topoleski LDT, Nascone JW, et al. Are locking screws advantageous with plate fixation of humeral shaft fractures? A biomechanical analysis of synthetic and cadaveric bone. J Orthop Trauma. 2008;22:709–15.PubMedCrossRef
18.
Zurück zum Zitat Rodriguez EK, Boulton C, Weaver MJ, Herder LM, Morgan JH, Chacko AT, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury. 2014;45:554–9.PubMedCrossRef Rodriguez EK, Boulton C, Weaver MJ, Herder LM, Morgan JH, Chacko AT, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury. 2014;45:554–9.PubMedCrossRef
19.•
Zurück zum Zitat Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28:83–9. Ricci et al. showed a secondary reoperation rate of 19 % with the use of locked plate fixation for distal femur fractures, a fracture commonly associated with osteoporosis. The identified risk factors for reoperation to promote union included open fracture, diabetes, smoking, increased body mass index, and shorter plate length. This illustrates that plate length, a surgeon modifiable risk factor, is an important consideration in construct design when treating osteoporotic fractures.PubMedCrossRef Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28:83–9. Ricci et al. showed a secondary reoperation rate of 19 % with the use of locked plate fixation for distal femur fractures, a fracture commonly associated with osteoporosis. The identified risk factors for reoperation to promote union included open fracture, diabetes, smoking, increased body mass index, and shorter plate length. This illustrates that plate length, a surgeon modifiable risk factor, is an important consideration in construct design when treating osteoporotic fractures.PubMedCrossRef
20.
Zurück zum Zitat Dalstrom DJ, Nelles DB, Patel V, Goswami T, Markert RJ, Prayson MJ. The protective effect of locking screw placement on nonlocking screw extraction torque in an osteoporotic supracondylar femur fracture model. J Orthop Trauma. 2012;26:523–7.PubMedCrossRef Dalstrom DJ, Nelles DB, Patel V, Goswami T, Markert RJ, Prayson MJ. The protective effect of locking screw placement on nonlocking screw extraction torque in an osteoporotic supracondylar femur fracture model. J Orthop Trauma. 2012;26:523–7.PubMedCrossRef
21.
Zurück zum Zitat Cui S, Bledsoe JG, Israel H, Watson JT, Cannada LK. Locked plating of comminuted distal femur fractures: does unlocked screw placement affect stability and failure? J Orthop Trauma. 2014;28:90–6.PubMedCrossRef Cui S, Bledsoe JG, Israel H, Watson JT, Cannada LK. Locked plating of comminuted distal femur fractures: does unlocked screw placement affect stability and failure? J Orthop Trauma. 2014;28:90–6.PubMedCrossRef
22.
Zurück zum Zitat Beingessner D, Moon E, Barei D, Morshed S. Biomechanical analysis of the less invasive stabilization system for mechanically unstable fractures of the distal femur: comparison of titanium versus stainless steel and bicortical versus unicortical fixation. J Trauma. 2011;71:620–4.PubMed Beingessner D, Moon E, Barei D, Morshed S. Biomechanical analysis of the less invasive stabilization system for mechanically unstable fractures of the distal femur: comparison of titanium versus stainless steel and bicortical versus unicortical fixation. J Trauma. 2011;71:620–4.PubMed
23.
Zurück zum Zitat Bottlang M. Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength. J Bone Joint Surg Am. 2009;91:1985.PubMedCentralPubMedCrossRef Bottlang M. Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength. J Bone Joint Surg Am. 2009;91:1985.PubMedCentralPubMedCrossRef
24.
Zurück zum Zitat Gardner MJ, Nork SE, Huber P, Krieg JC. Stiffness modulation of locking plate constructs using near cortical slotted holes: a preliminary study. J Orthop Trauma. 2009;23:281–7.PubMedCrossRef Gardner MJ, Nork SE, Huber P, Krieg JC. Stiffness modulation of locking plate constructs using near cortical slotted holes: a preliminary study. J Orthop Trauma. 2009;23:281–7.PubMedCrossRef
25.••
Zurück zum Zitat Bottlang M, Fitzpatrick DC, Sheerin D, Kubiak E, Gellman R, Vande Zandschulp C, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma. 2014;28:181–8. Bottlang et al. showed that far cortical locking improved union rates in the treatment of distal femur fractures with 30 of 31 fractures uniting and only one fracture needing revision for nonunion. There were no complications of loss of fixation when using far cortical locking screws proving this novel implant to be safe and effective.PubMedCrossRef Bottlang M, Fitzpatrick DC, Sheerin D, Kubiak E, Gellman R, Vande Zandschulp C, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma. 2014;28:181–8. Bottlang et al. showed that far cortical locking improved union rates in the treatment of distal femur fractures with 30 of 31 fractures uniting and only one fracture needing revision for nonunion. There were no complications of loss of fixation when using far cortical locking screws proving this novel implant to be safe and effective.PubMedCrossRef
26.
Zurück zum Zitat Doornink J, Fitzpatrick DC, Madey SM, Bottlang M. Far cortical locking enables flexible fixation with periarticular locking plates. J Orthop Trauma. 2011;25:S29–34.PubMedCentralPubMedCrossRef Doornink J, Fitzpatrick DC, Madey SM, Bottlang M. Far cortical locking enables flexible fixation with periarticular locking plates. J Orthop Trauma. 2011;25:S29–34.PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Jupiter JB, Winters S, Sigman S, Lowe C, Pappas C, Ladd AL, et al. Repair of five distal radius fractures with an investigational cancellous bone cement: a preliminary report. J Orthop Trauma. 1997;11:110–6.PubMedCrossRef Jupiter JB, Winters S, Sigman S, Lowe C, Pappas C, Ladd AL, et al. Repair of five distal radius fractures with an investigational cancellous bone cement: a preliminary report. J Orthop Trauma. 1997;11:110–6.PubMedCrossRef
28.
Zurück zum Zitat Cornell CN. Internal fracture fixation in patients with osteoporosis. JAm Acad of Orthop Surg. 2003;11:109–19. Cornell CN. Internal fracture fixation in patients with osteoporosis. JAm Acad of Orthop Surg. 2003;11:109–19.
29.
Zurück zum Zitat Bogunovic L, Cherney SM, Rothermich MA, Gardner MJ. Biomechanical considerations for surgical stabilization of osteoporotic fractures. Orthop Clin North Am. 2013;44:183–200.PubMedCrossRef Bogunovic L, Cherney SM, Rothermich MA, Gardner MJ. Biomechanical considerations for surgical stabilization of osteoporotic fractures. Orthop Clin North Am. 2013;44:183–200.PubMedCrossRef
30.
Zurück zum Zitat Moroni A, Toksvig-Larsen S, Maltarello MC, Orienti L, Stea S, Giannini S. A comparison of hydroxyapatite-coated, titanium-coated, and uncoated tapered external-fixation pins. An in vivo study in sheep. J Bone Joint Surg Am. 1998;80:547–54.PubMed Moroni A, Toksvig-Larsen S, Maltarello MC, Orienti L, Stea S, Giannini S. A comparison of hydroxyapatite-coated, titanium-coated, and uncoated tapered external-fixation pins. An in vivo study in sheep. J Bone Joint Surg Am. 1998;80:547–54.PubMed
31.
Zurück zum Zitat Agholme F, Andersson T, Tengvall P, Aspenberg P. Local bisphosphonate release versus hydroxyapatite coating for stainless steel screw fixation in rat tibiae. J Mater Sci Mater Med. 2012;23:743–52.PubMedCrossRef Agholme F, Andersson T, Tengvall P, Aspenberg P. Local bisphosphonate release versus hydroxyapatite coating for stainless steel screw fixation in rat tibiae. J Mater Sci Mater Med. 2012;23:743–52.PubMedCrossRef
32.
Zurück zum Zitat Wermelin K, Suska F, Tengvall P, Thomsen P, Aspenberg P. Stainless steel screws coated with bisphosphonates gave stronger fixation and more surrounding bone. Histomorphometry in rats Bone. 2008;42:365–71.CrossRef Wermelin K, Suska F, Tengvall P, Thomsen P, Aspenberg P. Stainless steel screws coated with bisphosphonates gave stronger fixation and more surrounding bone. Histomorphometry in rats Bone. 2008;42:365–71.CrossRef
33.
Zurück zum Zitat Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma. 2008;22:195–200.PubMedCrossRef Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma. 2008;22:195–200.PubMedCrossRef
34.
Zurück zum Zitat Bae JH, Oh JK, Chon C-S, Oh C-W, Hwang J-H, Yoon Y-C. The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. J Bone Joint Surg (Br). 2011;93:937–41.CrossRef Bae JH, Oh JK, Chon C-S, Oh C-W, Hwang J-H, Yoon Y-C. The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. J Bone Joint Surg (Br). 2011;93:937–41.CrossRef
35.
Zurück zum Zitat Assal M, Christofilopoulos P, Lübbeke A, Stern R. Augmented osteosynthesis of OTA 44-B fractures in older patients: a technique allowing early weightbearing. J Orthop Trauma. 2011;25:742–7.PubMedCrossRef Assal M, Christofilopoulos P, Lübbeke A, Stern R. Augmented osteosynthesis of OTA 44-B fractures in older patients: a technique allowing early weightbearing. J Orthop Trauma. 2011;25:742–7.PubMedCrossRef
36.
Zurück zum Zitat Kummer FJ, Koval KJ, Kauffman JI. Improving the distal fixation of intramedullary nails in osteoporotic bone. Bull (Hosp for Joint Dis (New York, NY)). 1997;56:88–90. Kummer FJ, Koval KJ, Kauffman JI. Improving the distal fixation of intramedullary nails in osteoporotic bone. Bull (Hosp for Joint Dis (New York, NY)). 1997;56:88–90.
37.
Zurück zum Zitat Paller DJ, Frenzen SW, Bartlett III CS, Beardsley CL, Beynnon BD. A three-dimensional comparison of intramedullary nail constructs for osteopenic supracondylar femur fractures. J Orthop Trauma. 2013;27:93–9.PubMedCrossRef Paller DJ, Frenzen SW, Bartlett III CS, Beardsley CL, Beynnon BD. A three-dimensional comparison of intramedullary nail constructs for osteopenic supracondylar femur fractures. J Orthop Trauma. 2013;27:93–9.PubMedCrossRef
38.
Zurück zum Zitat Tejwani NC, Park S, Iesaka K, Kummer F. The effect of locked distal screws in retrograde nailing of osteoporotic distal femur fractures: a laboratory study using cadaver femurs. J Orthop Trauma. 2005;19:380–3.PubMedCrossRef Tejwani NC, Park S, Iesaka K, Kummer F. The effect of locked distal screws in retrograde nailing of osteoporotic distal femur fractures: a laboratory study using cadaver femurs. J Orthop Trauma. 2005;19:380–3.PubMedCrossRef
39.
Zurück zum Zitat Sha M, Guo Z, Fu J, Li J, Yuan CF, Shi L, et al. The effects of nail rigidity on fracture healing in rats with osteoporosis. SORT. 2009;80:135–8.CrossRef Sha M, Guo Z, Fu J, Li J, Yuan CF, Shi L, et al. The effects of nail rigidity on fracture healing in rats with osteoporosis. SORT. 2009;80:135–8.CrossRef
40.
Zurück zum Zitat Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint Surg Am. 2003;85-A:820–4.PubMed Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint Surg Am. 2003;85-A:820–4.PubMed
41.
Zurück zum Zitat Olsen JR, Hunter J, Baumhauer JF. Osteoporotic ankle fractures. Orthop Clin North Am. 2013;44:225–41.PubMedCrossRef Olsen JR, Hunter J, Baumhauer JF. Osteoporotic ankle fractures. Orthop Clin North Am. 2013;44:225–41.PubMedCrossRef
42.
Zurück zum Zitat Pollard JD, Deyhim A, Rigby RB, Dau N, King C, Fallat LM, et al. Comparison of pullout strength between 3.5-mm fully threaded, bicortical screws and 4.0-mm partially threaded, cancellous screws in the fixation of medial malleolar fractures. J foot and ankle surg: ofF publ Am College of Foot and Ankle Surg. 2010;49:248–52.CrossRef Pollard JD, Deyhim A, Rigby RB, Dau N, King C, Fallat LM, et al. Comparison of pullout strength between 3.5-mm fully threaded, bicortical screws and 4.0-mm partially threaded, cancellous screws in the fixation of medial malleolar fractures. J foot and ankle surg: ofF publ Am College of Foot and Ankle Surg. 2010;49:248–52.CrossRef
43.
Zurück zum Zitat King CM, Cobb M, Collman DR, Lagaay PM, Pollard JD. Bicortical fixation of medial malleolar fractures: a review of 23 cases at risk for complicated bone healing. J foot and ankle surg: ofF publ Am College of Foot and Ankle Surg. 2012;51:39–44.CrossRef King CM, Cobb M, Collman DR, Lagaay PM, Pollard JD. Bicortical fixation of medial malleolar fractures: a review of 23 cases at risk for complicated bone healing. J foot and ankle surg: ofF publ Am College of Foot and Ankle Surg. 2012;51:39–44.CrossRef
44.
Zurück zum Zitat Fowler TT, Pugh KJ, Litsky AS, Taylor BC, French BG. Medial malleolar fractures: a biomechanical study of fixation techniques. Orthopedics. 2011;34:e349–55.PubMed Fowler TT, Pugh KJ, Litsky AS, Taylor BC, French BG. Medial malleolar fractures: a biomechanical study of fixation techniques. Orthopedics. 2011;34:e349–55.PubMed
45.
Zurück zum Zitat Ricci WM, Tornetta P, Borrelli Jr J. Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. J Orthop Trauma. 2012;26:602–6.PubMedCrossRef Ricci WM, Tornetta P, Borrelli Jr J. Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. J Orthop Trauma. 2012;26:602–6.PubMedCrossRef
46.
Zurück zum Zitat McLaurin TM. Proximal humerus fractures in the elderly are we operating on too many? Bulletin (Hospital for Joint Diseases (New York, NY)). 2004;62:24–32. McLaurin TM. Proximal humerus fractures in the elderly are we operating on too many? Bulletin (Hospital for Joint Diseases (New York, NY)). 2004;62:24–32.
47.
Zurück zum Zitat Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011;20:747–55.PubMedCrossRef Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011;20:747–55.PubMedCrossRef
48.•
Zurück zum Zitat Zhu Y, Lu Y, Shen J, Zhang J, Jiang C. Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures: a prospective randomized trial with a minimum of three years of follow-up. J Bone Joint Surg. 2011;93:159–68.PubMedCrossRef Zhu Y, Lu Y, Shen J, Zhang J, Jiang C. Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures: a prospective randomized trial with a minimum of three years of follow-up. J Bone Joint Surg. 2011;93:159–68.PubMedCrossRef
49.
Zurück zum Zitat Yoon RS, Dziadosz D, Porter DA, Frank MA, Smith WR, Liporace FA. A comprehensive update on current fixation options for two-part proximal humerus fractures: a biomechanical investigation. Injury. 2014;45:510–4.PubMedCrossRef Yoon RS, Dziadosz D, Porter DA, Frank MA, Smith WR, Liporace FA. A comprehensive update on current fixation options for two-part proximal humerus fractures: a biomechanical investigation. Injury. 2014;45:510–4.PubMedCrossRef
Metadaten
Titel
Internal Fixation of Osteoporotic Fractures
verfasst von
David L. Rothberg
Mark A. Lee
Publikationsdatum
01.02.2015
Verlag
Springer US
Erschienen in
Current Osteoporosis Reports / Ausgabe 1/2015
Print ISSN: 1544-1873
Elektronische ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-014-0245-9

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