Table Of ContentI F O B
NTERNAL IXATION IN STEOPOROTIC ONE
I F O B
NTERNAL IXATION IN STEOPOROTIC ONE
Edited by
Yuehuei H. An, M.D.
Associate Professor and Director, Orthopaedic Research Laboratory
Department of Orthopaedic Surgery
Medical University of South Carolina
Charleston, South Carolina
Adjunct Assistant Professor
Department of Bioengineering
Clemson University
Clemson, South Carolina
Thieme
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Library of Congress Cataloging-in-Publication Data
Internal fixation in osteoporotic bone / edited by Yuehuei H. An.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58890-087-8 (hard cover) — ISBN 3131284714 (hard cover)
1. Osteoporosis. 2. Internal fixation in fractures. 3. Surgical instruments and apparatus.
I. An, Yuehuei H.
[DNLM: 1. Osteoporosis—therapy. 2. External Fixators. 3. Internal Fixators. WE 250
I605 2002]
RD103.I5 I467 2002
616.7’16—dc21
2002019432
Copyright © 2002 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected
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Printed in the United States of America
5 4 3 2 1
TNYISBN 1-58890-087-8
GTV ISBN 3-13-128471-4
To Q. Kay Kang, M.D.
Without her love, inspiration, and support, this book would not have been possible.
C
ONTENTS
FOREWORD ix
PREFACE xi
CONTRIBUTORS xii
SECTIONI. ESSENTIALSOFOSTEOPOROSIS
1. Pathogenesis and Histomorphology of Osteoporosis—Helen E. Gruber 3
2. Biomechanics of Osteoporotic Bone and Fractures—Nozomu Inoue and Edmund Y.S. Chao 9
3. Biology and Biomechanics of Fracture Healing—William R. Walsh, Yan Yu, Jia Lin Yang,
R. Hocking, P. Chapman-Sheath, and Warwick Bruce 22
4. Mechanisms of Internal Fixation of Bone—Allan F. Tencer 40
5. Imaging and Bone Densitometry of Osteoporosis—Sven Prevrhal, Christopher F. Njeh,
Michael Jergas, and Harry K. Genant 51
SECTIONII. CURRENTCLINICALTECHNIQUES
6. Current Methods and Trends in Fixation of Osteoporotic Bone—Yuehuei H. An,
Chadler R. Burgoyne, Matthew S. Crum, and John A. Glaser 73
7. Basic Principles and Techniques of Internal Fixation in Osteoporotic Bone—Ralph Hertel
and Bernhard Jost 108
8. Internal Fixation of Osteoporotic Long Bone—Charles N. Cornell 116
9. Internal Fixation of Osteoporotic Spine—Kazuhiro Hasegawa and Toru Hirano 128
10. Internal Fixation of Osteoporotic Acetabular and Pelvic Fractures—Dana C. Mears and
Simon C. Mears 137
11. Internal Fixation in Patients with Paget’s Disease—Frederick S. Kaplan and David L. Glaser 156
12. Internal Fixation in Patients with Osteogenesis Imperfecta—Lewis E. Zionts and Edward
Ebramzadeh 162
13. Bone Fixation in Patients with Bone Tumors—Kamron Aflatoon, Deborah Anne Frassica,
Nozomu Inoue, and Frank J. Frassica 178
14. External Fixation in Osteoporotic Bone—J. Carel Goslings 186
15. Fracture Prevention and Medical Treatment of Osteoporosis—Joseph M. Lane, Linda
Russell, and Safdar N. Khan 194
vii
viii • CONTENTS
SECTIONIII. NEWCLINICALAPPLICATIONSANDNOVELCONCEPTS: BONESCREWS, PINS,
ANDAUGMENTATION
16. Norian SRS Resorbable Cement for Augmentation of Internal Fixation of Hip Fractures—
Stuart B. Goodman and Sune Larsson 207
17. Fixation of Unstable Osteoporotic Intertrochanteric Fractures Using the DHS and a Glass-
Ionomer Cement—Lutz E. Claes, Christiane Becker, Martin Simnacher, and Ingolf Hoellen 217
18. Enhanced Stability of External Fixation with Hydroxyapatite-Coated Pins—Antonio
Moroni 224
19. Internal Fixation of Osteoporotic Proximal Femoral Fractures Using a Novel Device
Enhanced by Hydroxyapatite Granules—Kazuhiro Hasegawa 232
20. An Interlocking Screw for Fixation in Osteoporotic Bone—Brodie E. McKoy, Geoffrey S.
Connor, and Yuehuei H. An 237
21. An Injectable Cementing Screw for Fixation in Osteoporotic Bone—Brodie E. McKoy
and Yuehuei H. An 242
22. ACement Screw for Fixation in Osteoporotic Metaphyseal Bone—Peter A. Reynders
and Luc A. Labey 248
SECTIONIV. NEWCLINICALAPPLICATIONSANDNOVELCONCEPTS: BONEPLATES
23. Resorbable Implants as a Means of Augmenting Metal Plate Fixation in Osteoporotic
Bone—Sylwester Gogolewski 259
24. Interlocked Blade Plates in the Treatment of Osteoporotic Metaphyseal Fractures—
Simon H. Palmer 266
25. LISS Plate Fixation of Periprosthetic Supracondylar Femur Fractures—Kyle E. Watford,
Philip J. Kregor, and Langdon A. Hartsock 271
26. An Axially Mobile Plate for Fracture Fixation—Eric W. Abel, Jun Sun, and David I. Rowley 279
SECTIONV. NEWCLINICALAPPLICATIONSANDNOVELCONCEPTS: INTRAMEDULLARYNAILS
27. The Huckstep Nail for Fixation of Mechanically Deficient Femoral Bone—Nasser M. Kurdy
and Charles I. Ayekoloye 287
28. Intramedullary Cement Fixation of Proximal Humeral Fractures in the Elderly Patient—
Masahiko Matsuda 292
29. Synthes Spiral Blade Intramedullary Nail System for Proximal Humeral Fractures—
Jeffrey M. Conrad, Michael S.Wildstein, and Langdon A. Hartsock 296
30. An Expandable Intramedullary Nail for Fixation in Osteoporotic Bone—Nadav Shasha,
Nehemia Blumberg, Michael Tauber, and Shmuel Dekel 301
31. Improving the Distal Fixation of Intramedullary Nails in Osteoporotic Bone—Frederick J.
Kummer 310
SECTIONVI. NEWCLINICALAPPLICATIONSANDNOVELCONCEPTS: SPINALFIXATION
32. Percutaneous Vertebroplasty Using Bone Cement for Compromised Vertebral Bodies—
Bernard Cortet, Pierre Hardouin, and Anne Cotten 317
33. Vertebroplasty with Inflatable Bone Tamps and Calcium-Phosphate Cement—Jorrit-Jan
Verlaan, F. Cumhur Oner, Abraham J. Verbout, and Wouter J.A. Dhert 325
34. Minimally Invasive Surgery for the Treatment of Vertebral Compression Fractures—
Joseph M. Lane, Safdar N. Khan, Federico P. Girardi, and Frank P. Cammisa, Jr. 334
35. ASelf-Guided Pedicle Screw for Anterior Fixation of Cervical Spine—Baoren Liu and
Yuehuei H. An 342
36. TPS Devices for Treatment of Vertebral Tumors and Pathological Compression Fractures—
Jean-Valéry C.E. Coumans, Connie P. Marchek, and Fraser C. Henderson 349
INDEX 359
F
OREWORD
Fractures in the elderly have recently seen a marked The healing quality of the elderly with osteo-
increase in frequency and severity. The subsequent porotic bone seems to be clinically a less important
pain and disability result in a diminished quality of problem, provided the fracture can be fixed properly.
life and suffering for the patient. For the community, However, any possibility to improve the healing pro-
these disabilities create substantial costs because, ac- cess is desired. Furthermore, to reduce suffering and
cording to recent reports, a large percentage of pa- cost, research into avoidance of osteoporosis based
tients with proximal femoral fractures, for example, on a better understanding of molecular biology to
remain bedridden or require ongoing assistance. In supplement knowledge of conventional biochem-
the acute phase immediately after the fracture, bed istry remains a priority.
rest must be minimized to avoid the lethal risk of cir- This book deals extensively with both the biome-
culatory and pulmonary complications. Therefore, chanical and the biological aspects of surgical treat-
the main goal of treatment for fractures of the lower ment of fractures in osteoporotic bone. An outstand-
limb, pelvis, and spine is to achieve early ambula- ing balance between the “mechanistic” and
tion. Clinical experience has shown that when the “molecular” world and between clinical and research
pain is reduced faster and mobility and ambulation is aspects has been achieved. The wealth of direct and
restored, the chances for survival are better. This in quoted information provided is a valuable contribu-
turn requires a high quality of internal fixation in a tion to the researcher and clinician alike. The many
difficult setting. methods of research and the often impressive variety
Osteoporotic bone is not only less strong but also of techniques, tools, and implants indicate that we
lacks toughness. Brittle bone is even less forgiving. are still in search of desperately needed improve-
The problem is compounded by the fact that at the ments. In some areas, such as in fractures of the
same time as bone softens, the brain hardens; that is, humeral head, the variety of procedures is propor-
it loses the control of the locomotor function result- tional to the difficulty of the treatment. In respect to
ing in increased incidence of fractures and, more im- the frequent fractures of the forearm, interesting new
portantly, in loss of control of loading after fracture developments allowing maintenance of mobility are
treatment. The weakness and brittleness of the osteo- reported.
porotic bone limit its load-bearing capacity, whereas The editor, Yuehuei H. An, has added one more
the internal fixation must withstand higher, uncon- outstanding contribution in the field of applied re-
trolled loads. Paradoxically, stronger implants do not search and clinical treatment. We congratulate him
help; they are usually more rigid and rigid implants and wish this book well-deserved success!
increase the stress at the interface between implant
and bone—a serious vicious circle. To improve this
condition, therefore, animal models allowing re-
search into internal fixation in osteoporotic bone are Stephan M. Perren, M.D., D.Sc.
of basic importance. They should lead to finding the Professor
proper balance between stability for painless func- AO/ASIF Research Institute
tion and controlled instability for prompt healing. Davos, Switzerland
ix
