RE-FRACTURE AS IMPACT OF RIGID IMPLANT AND BONE OSTEOPOROSIS: A CASE REPORT
Background: The increasing life expectancy of the world population associated with osteopenia and osteoporosis leads to low-energy fractures, especially in the lower limb. The overture of locking plates has widened the area of close fracture fixation, and it is essential to justify and optimize their usage. This study aims to report the potential postoperative re-fracture after implant removal and as a consequence of bone osteoporosis.
Case report: We present a re-fracture of proximal femur case in 60 years old female after a trivial fall into her right femur. This patient underwent a removal implant surgery a week before in the same spot where she fell. The open surgery was made with the same incision, and we do the Open Reduction Internal Fixation for her.
Discussion: The major design of the fixation tool is to secure the fracture with less effect on native axial load stress from the whole bone. Stress shielding caused due to firm bone-implant results in its resorption. The bone degradation underneath gives rise to the plate's collapse, resulting in repeated bone breakage. Early discharge, continued weight-bearing training for proximal femur fractures were associated with speedy improvement in daily activities. The photodynamic polymer liquid was the latest technology for bone stabilization.
Conclusion: Rigid bone plates can cause stress shielding, and when the implants are removed, re-fracture easily happens. Therefore, discharge of patients quickly for weight-bearing training in proximal femur fractures was encouraged to promote better healing.
Carneiro MB, Alves D, Mercadante MT. Physical therapy in the postoperative of proximal femur fracture in elderly. Literature review. Acta Ortop Bras. 2013. 21(3):175-8.
Casp AJ, Montgomery SR, Cancienne JM, Brockmeier SF, Werner BC. Osteoporosis and Implant-Related Complications After Anatomic and Reverse Total Shoulder Arthroplasty. J Am Acad Orthop Surg. 2020;28(3):121–7.
Nandakumar R, Abraham VT, Prabhakaran A, Chandrasekaran M, Weight E. Early Weight Bearing Following Intertrochanteric Fractures Managed with Proximal Femoral Nail; Are We Obsessed with Complications? Int J Orthop Traumatol Surg Sci. 2016;2(1):255–8.
Hodel S, Beeres FJP, Babst R, Link B-C. Complications following proximal femoral locking compression plating in unstable proximal femur fractures: medium-term follow-up. Eur J Orthop Surg Traumatol. 2017;27(8):1117–24.
Bel J-C. Pitfalls and limits of locking plates. Orthop Traumatol Surg Res. 2019;105(1S):S103-9.
Wang L, Ding G-Z, Yang M. Analysis of the clinical risk factors of re-fracture after osteoporotic fracture. 2020;1–16.
Kim T, Wang See C, Li X, Zhu D. Orthopedic implants and devices for bone fractures and defects: Past, present, and perspective. Eng Regen. 2020;1:6–18.
Sheen JR, Garla VV. Fracture Healing Overview. In: StatPearls (Internet). Treasure Island (FL): StatPearl Publishing; 2021.
Fice J, Chandrashekar N. Tapered Fracture Fixation Plate Reduces Bone Stress Shielding: A Computational Study. J Mech Med Biol. 2012;12(4).
Irish J, Virdi AS, Sena K, McNulty MA, Sumner DR. Implant placement increases bone remodeling transiently in a rat model. J Orthop Res. 2013;31(5):800–6.
Li Z, Kuhn G, von Salis-Soglio M, Cooke SJ, Schirmer M, Müller R, et al. In vivo monitoring of bone architecture and remodeling after implant insertion: The different responses of cortical and trabecular bone. Bone. 2015;81:468–77.
Khosravi N, Maeda A, DaCosta RS, Davies JE. Nanosurfaces modulate the mechanism peri-implant endosseous healing by regulating neovascular morphogegenesis. Commun Biol. 2018;1:72.
Müftü S, Chou H-Y. Simulation of peri-implant bone healing due to immediate loading in dental implant treatments. J Biomech. 2013;46(5):871-8.
Consigliere P, Iliopoulos E, Ads T, Trompeter A. Early versus delayed weight-bearing after surgical fixation of distal femur fractures: a non-randomized comparative study. Eur J Orthop Surg Traumatol. 2019;29(8):1789–94.
Singh AK, Narsaria N, Gupta RK. A biomechanical study comparing proximal femur nail and proximal femur locking compression plate in fixation of reverse oblique proximal femur fractures. Injury. 2017;48(10):2050–3.
Kubiak EN, Beebe MJ, North K, Hitchcock R, Potter MQ. Early weight-bearing after lower extremity fractures in adults. J Am Acad Orthop Surg. 2013;21(12):727–38.
Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006;76(7):607–11.
Vegt P, Muir JM, Block JE. The Photodynamic Bone stabilization system: a minimally invasive, percutaneous intramedullary polymeric osteosynthesis for simple and complex long bone fractures. Med Devices (Auckl). 2014;(7):453–61.
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