Research Projects

Symposiums

Osteoporosis and the Myth of Colles: Do they all do well?
AAOS San Francisco, CA– Wrist Symposium
Sunday March 9th, 2008
8:30am-10:30am
 
NONOPERATIVE AND MINIMALLY INVASIVE TREATMENT:WHEN I USE IT
TERRY AXELROD MD

INTERNAL FIXATION: IS THIS THE NEW GOLD STANDARD?
AMY L. LADD MD

CONTEMPORARY PERSPECTIVES ON THE ROLE OF STABLE INTERNAL FIXATION WITH OSTEOPOROTIC WRIST FRACTURES
JESSE JUPITER MD


FIXATION AUGMENTATION TECHNIQUES: WHEN AND HOW
ANTONIO MORONI MD

OSTEOPOROSIS: NOT JUST FOR LITTLE OLD LADIES
AENOR SAWYER MD
 
The common but misunderstood osteoporotic distal radius fracture deserves scrutiny and special consideration. This symposium moderated by Dr. Amy Ladd (Stanford University, US) will elucidate steps for improved recognition and treatment. The three primary aims will be to identify major contributions to the past and current trends in wrist fracture treatment, identify risk factors and co-morbidities in patients with osteopenic and osteoporotic related fractures and recognize characteristics of osteoporotic fractures that potentially complicate treatment.
 
The myth that Sir Abraham Colles said of the fracture "they all do well" has persisted with at least some foundation. With our expanding elderly population, many leading active lifestyles, we have greater experience with what fractures indeed do well with minimal intervention. Surgical outcome may be unsatisfactory because of the difficulty in obtaining reliable fixation in mechanically weak bone. Some low demand patients may accept wrist deformity, and some may also accept degrees of dysfunction. Even in the face of optimal wrist alignment--with or without surgery--functional return may be independent of alignment, or difficult to regain. Dr. Axelrod is an expert in nonoperative and less invasive procedures for treating distal radius fractures - he will address why the myth that "they all do well" has persisted with at least some foundation. The goal of this presentation will be to discuss the degree of deformity that is acceptable in general and specific terms, and to present techniques for minimizing deformity with little or no surgical intervention.
 
 It is a historical misconception that Abraham Colles said to leave the fractured radius alone. In fact, he advocated early, aggressive treatment with manipulative reduction and splinting, even for what in 1814 was likely a low energy osteoporotic fracture. Dr. Amy Ladd will present on internal fixation techniques. Stable internal fixation can result in earlier wrist motion, and anatomic reduction potentially provides better function. Furthermore, depressed articular fragments, coronal split fragments involving the lunate facet, and volar shearing are difficult to control without internal fixation. Internal fixation provides the best restoration and opportunity to minimize arthritis, if the benefits outweigh the associated risks and co-morbidities of treatment.
  
The development of angular stable internal fixation devices combined with newer operative approaches has enabled earlier and more predictable functional recovery as well as a return to the independence for the older age patient with an unstable distal radius fracture. Patient-rated and physician-rated outcomes have demonstrated the safety and efficacy of this approach and will be presented by Dr. Jesse Jupiter, leading expert in current concepts of distal radius fracture treatment including appropriate indications, technique and potential pitfalls.
 
Often the orthopaedic surgeon is first to recognize the fragility fracture, and thus the first to make the diagnosis of osteopenia and osteoporosis. To date, diagnostic tools such as dual energy x-ray absorptiometry (DXA) scans are readily available to assess bone quality, and improved scanning techniques are on the horizon. Regrettably, qualitative information regarding hardware fixation potential is an educated guess at best. Professor Moroni is an expert on adjunctive techniques in osteoporotic fracture treatment, and provides an international perspective. Choosing surgical treatment, type of fixation, and need for augmentation with graft, substitutes, or other adjunctive methods is typically an intraoperative decision. Fixation augmentation techniques that increase implant stability will be discussed, including synthetic grafting and implants coated with hydroxyapatite.
 
Fragility fractures associated with peri-menopause are near epidemic in American society, and in many nations around the world. Men, however, are sustaining the fractures in an increasing rate, and have a higher proportion of hip fractures--and associated mortality--than women. Furthermore, the greatest bone deposition occurs in the four years before puberty, and the incidence of pediatric fractures has also escalated. Dr. Aenor Sawyer is a pediatric orthopaedist with an expertise in osteoporosis, and will enlighten the audiences on the concept that osteoporosis is a pediatric disease. She will address the demographics, detection, and potential prevention of fragility fractures and their co-morbidities.