Surgical treatment of osteoporotic knee fractures

Abstract

Operative fixation options of osteoporotic supracondylar fractures of the knee include open reduction and internal fixation, intramedullary nailing, and bridge plating or percutaneous submuscular plating techniques. As with any fracture, treatment choice must be individualized according to the nature of the injury, bone quality, and patient demand. Regardless of treatment method, goals include restoration of articular congruity, anatomical length, rotation, and axial alignment while establishing adequate fixation to initiate early and unrestricted range of motion. Displaced tibial plateau fractures must be treated with internal fixation using autologous bone grafting to provide structural support. In comminuted and osteoporotic fractures, there can be insufficient autograft available for this. Fresh-frozen bone allograft is readily available in sufficient quantity to fill all voids, is relatively inexpensive, and avoids donor site morbidity. Intra-articular fractures of the proximal tibia that extend to the meta-diaphyseal part of the bone represent a severe injury, especially if they occur in osteoporotic patients. Current treatment modalities include either internal fixation with traditional or modern plating techniques or external fixation with circular frames or hybrid systems. However, problems and complications related with these techniques are increasing with age, and future reconstructive operations, such as TKA, may be jeopardized. Further studies have to depict whether the new bilateral fixed-angle plate osteosynthesis of the patella displays advantages over the established operative procedures (modified anterior tension wiring with K-wires and cannulated lag screws with anterior tension wiring).