This article is more than 5 years old. Information may no longer be current.
Speaker: Stabilization of entire bone in patients with fragility fractures avoids secondary risk
Click Here to Manage Email Alerts
NATIONAL HARBOR, Md. — Aaron Nauth, MD, urged his colleagues to provide stable and immediate fixation of the entire bone in patients with fragility fractures to avoid the risk of secondary fractures.
“There is a fairly robust basic science evidence that fracture healing is impaired in these individuals both due to age-related and non-age-related phenomena, but is this a problem clinically? Not really,” he said during the Fracture Healing Controversies Symposium at the Orthopaedic Trauma Association Annual Meeting. “If you look at the clinical literature, nonunion or delayed union [is] not a problem in these patients. The problem is their bone stock.”
Patients with fragility fractures have poor bone stock, which is often present with comminuted fractures and because of this, fixation is compromised, he said. Patients usually have had previous surgery and have hardware present from arthroplasty or previous fractures.
“[These patients] are also frail patients. They do not tolerate restrictive weight-bearing and they are at substantial risk of repeat falls, and that increases their risk of secondary fracture adjacent to the implants,” Nauth said.
In order to manage patients with fragility fractures, Nauth recommended orthopedists follow these guidelines: replace the bone instead of fixing it; use a nail or allograft; stabilize the entire bone; and do not forget about general fracture principles.
“In my experience, we rarely need to address the fracture biology. What you need to address is stable and immediate fixation. You want to allow these patients to weigh-bear early and mobilize early. You need to stabilize the entire bone in general if you can, and this avoids their risk of secondary fractures,” Nauth said. – by Nhu Te
Reference:
Nauth A. The extreme fragility fracture: What do I do differently. Presented at: Orthopaedic Trauma Association; Oct. 5-8, 2016; National Harbor, Md.
Disclosure: Nauth reports he receives research support from Capital Sports Entertainment, DePuy Synthes, Stryker, Sonoma Orthopaedics and the Canadian Trauma Society; and is a board member for the Orthopaedic Trauma Association.