Alternatives In Fixation For Osteoporotic Bone

Start Page: 54
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Author(s): 
Davi Cross, DPM, and Lawrence A. DiDomenico, DPM, FACFAS

What About Post-Op Considerations?

Postoperative management is another key component when caring for patients with osteoporotic bone. It important to keep in mind that extended periods of immobilization or non-weightbearing may significantly impact long-term joint range of motion as well as negatively impact already depleted bone density values.26 This factor is another reason for judicious application of fixation methods in these patients.

   The surgeon should also keep in mind that comorbidities as well as cigarette smoking can be complicating factors and have deleterious effects on the outcomes of these patients.2,5 In a study of complications after ankle fracture in elderly patients, Lynde and co-workers found 18.18 percent and 10.87 percent complication rates in patients with and without comorbidities respectively.16

Final Thoughts

An abundance of fixation options are available for osteoporotic bone. Plating and non-plating modalities each offer their own benefits with the literature demonstrating mixed reviews of each. An expedited postoperative course offers patients earlier mobilization and all the corresponding benefits. In addition, the surgeon should keep in mind that thorough evaluation of patient comorbidities is a key factor for determining outcome.

   Dr. Cross is a third-year resident at Heritage Valley Health System Residency Program in Beaver, Pa.

   Dr. DiDomenico is affiliated with the Forum Health/Western Reserve Care System in Youngstown, Ohio. He is the Section Chief of Podiatry at St. Elizabeth’s Hospital in Youngstown, Ohio. He is the Director of the Reconstructive Rearfoot and Ankle Surgical Fellowship within the Ankle and Foot Care Centers and the Ohio College of Podiatric Medicine. Dr. DiDomenico is a Fellow of the American College of Foot and Ankle Surgeons.

References

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