Current Aspects of Fragility Fracture Repair

Abstract

Due to the demographic developments worldwide, fragility fractures represent an increasing problem for the public health system. The risk of developing osteoporosis increases with age and is relatively higher in women and in the Caucasian population. The stability of bone is reduced because of accentuation of the normal loss of bone mass in ageing, leading to an increased susceptibility to fracture with an increased rate of complications after surgical stabilization. Due to this, the orthopedic surgeon has to assess the quality of the bone during preoperative planning and select the implants and postoperative care accordingly to achieve the best. Over the last 10 years fixed locking implants have been introduced into clinical practice. These represent a new type of angle stable fixation devices that address the mechanical instability between bone and implant. The novel problems associated with this device are due to higher cut-out rates when the bone structure is altered and mass is reduced. The developments in joint replacement have also resulted in longer standing times and lower complication rates with immediate fullweight-bearing after implantation. However, to date, little is known about the mechanisms of fracture healing in osteoporosis or fragility fractures. One future approach may be in supporting biological fracture healing by regenerative therapies using growth hormones and/or (stem) cells. The most frequent initial clinical symptom of osteoporosis is a fracture without a relevant trauma. At this stage, the trauma surgeon should initiate diagnostic procedures, treatment of osteoporosis and tertiary prevention according to the European guidelines. Ultimately, all female patients older than 50 years and all male patients older than 60 years with fractures should be assessed and treated for bone quality. Orthogeriatric specialists or interdisciplinary orthogeriatric teams should initiate a specific surgical treatment followed by early rehabilitation in order to allow the elderly patient to return to daily living as soon as possible.

Silica‐based mesoporous nanobiomaterials as promoter of bone regeneration process

“…However, for particular patients with abnormal calcium metabolism, such as postmenopausal women, bone sorption rate is obviously higher than that of bone formation which results in long‐term osteoporosis and challenged bone fracture healing. Therefore, a more effective method to promote fracture healing is becoming a research hotspot …”

“…Therefore, a more effective method to promote fracture healing is becoming a research hotspot. 69 In an attempt to improve implant-bone integration and accelerate bone fracture healing by resisting osteoclastic resorption, Zhu et al 70 employed a novel procedure to develop a mesoporous silica nanoparticles/hydroxyapatite (SMNs/HA) composite coating onto stainless Kirschner wire substrate. In this work, zoledronic acid (ZOL) as a model drug was immobilized in the mesoporous coating toward decreasing osteoclastic resorption activity.…”

Mesoporous Silica Nanoparticles/Hydroxyapatite Composite Coated Implants to Locally Inhibit Osteoclastic Activity

“…Therefore, searching for a more effective method to promote fracture healing is becoming a research hotspot. 2,3 On basis of the successful application of artificial hip joint coatings, biological coated-internal fixation implants has shown great potentials in accelerating fracture healing through incorporating and locally release bioactive components. 4,5 However, bioactive molecules like the growth factors (e.g., insulin-like growth factors, transforming growth factor-β) 6,7 and bone morphology proteins (BMPs) 8 have large molecular weight, thus inhibit high drug capacity.…”

“…However, for particular patients with abnormal calcium metabolism, such as postmenopausal women, bone sorption rate is obviously higher than that of bone formation which results in long term osteoporosis and hard bone fracture healing. Therefore, searching for a more effective method to promote fracture healing is becoming a research hotspot. , …”

Focus on Skeletal Bone Diseases – Osteoporosis and Paget’s Disease of Bone

“…In the paper Current Aspects of Fragility Fracture Repair, Grote et al [2] address the second and third questions. They focus on the diagnosis of fragility fractures, our standard surgical protocol for treating these fractures, and the development of angular stable locking implants, which have obviously made life easier for us -the orthopedic trauma surgeons treating these patients.…”