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Written by Amy
Tuesday, 17 May 2005

AAOS 2006- Management of Osteoporotic Wrist Fractures

March 26th, 2006
8am-10am
Chicago,IL, US

SYNOPSIS

As the elderly population continues to grow, osteoporotic distal forearm fractures are becoming increasingly common. The surgical outcome is often less than satisfactory because of the difficulty in obtaining reliable fixation in mechanically weak bone. This may result in wrist deformity and dysfunction. This symposium will focus on the latest advances in surgical treatment including external fixation, minimally-invasive techniques and plates with locking screws. Fixation augmentation techniques such as implants coated with hydroxyapatite, calcium phosphate cements and other orthobiologics will be presented. This symposium is designed to help attendees manage these challenging fractures using a truly multi-factorial approach.

Management of Osteoporotic Wrist Fractures

Dr. Terry Axelrod, Sunnybrook Hospital, Toronto, Canada

Dr. Amy Ladd, Robert A. Chase Hand & Upper Limb Center Chief, Pediatric Hand Clinic, Lucile Packard Children's Hospital, Palo Alto, CA

Dr. Antonio Moroni, Rizzoli Orthopaedic Institute, Bologna, Italy

Dr. Jesse Jupiter, Massachusetts General Hospital, Hand and Upper Extremity Service, Boston, MA

Dr. Charles Melone, New York, US

As the elderly population continues to grow, osteoporotic distal forearm fractures are becoming increasingly common. The surgical outcome is often less than satisfactory because of the difficulty in obtaining reliable fixation in mechanically weak bone, which may result in wrist deformity and dysfunction. While many older patients have limited functional demands and can accept this, others remain very active into older age and desire optimal wrist alignment and function. This symposium will focus on the latest advances in surgical treatment. External fixation is widely-used because of its simplicity. The appropriate indications for concomitant external fixation and bridging versus non-bridging techniques will be reviewed. Furthermore, methods of reducing pin loosening and infection will be examined. Internal fixation has become more popular recently. While the argument that stable internal fixation can result in earlier wrist motion, and therefore better results has yet to be substantiated, there are fractures that are difficult to control without internal fixation (such as fractures involving a coronal split in the lunate facet of the distal radius) and some for which internal fixation is agreed to be the best treatment method, such as volar shearing fracture of the articular surface. Minimally-invasive techniques are becoming increasingly popular because of the reduced incidence of morbidity and faster recovery. Emphasis will be placed on the most prominent minimally-invasive techniques featuring various implant types designed for osteoporotic wrist fixation. Furthermore, 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 along with indications, technique and potential pitfalls. Fixation augmentation techniques such as implants coated with hydroxyapatite will be presented. Hydroxyapatite-coated screws have shown optimal fixation and osteointegration ability even in osteoporotic wrist fractures. Clinical studies show a reduced incidence of screw loosening for this type of fragility fracture. New developments in so-called “orthobiologics” such as calcium phosphate cements could provide opportunities for improving implant stability and thereby minimizing failures. However, calcium phosphate cements are not as useful as initially hoped. The drawbacks of these cements, combined with their expense, have limited their use. This symposium is designed to help attendees manage these challenging fractures using a truly multi-factorial approach.

Last Updated ( Thursday, 03 November 2005 )