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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...
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Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during bone...
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Alendronate improves screw fixation in osteoporotic bone.

Antonio Moroni1, Cesare Faldini, Amy Hoang-Kim

  • 1Rizzoli Orthopaedic Institute, University of Bologna, Via GC Pupilli 1, 40136 Bologna, Italy. a.moroni@ior.it

The Journal of Bone and Joint Surgery. American Volume
|January 4, 2007
PubMed
Summary

Systemic alendronate significantly improved screw fixation in the cancellous bone of osteoporotic pertrochanteric fractures. This bisphosphonate therapy doubled the extraction torque in the femoral head, aiding bone healing.

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Area of Science:

  • Orthopedic Surgery
  • Pharmacology
  • Bone Metabolism

Background:

  • Bisphosphonates are known to enhance screw fixation in bone, as shown in animal studies.
  • Osteoporotic pertrochanteric fractures present challenges for screw fixation due to reduced bone density.

Purpose of the Study:

  • To evaluate the efficacy of systemic bisphosphonate administration in improving screw fixation in hydroxyapatite-coated screws used for pertrochanteric fractures in osteoporotic bone.
  • To assess the impact of alendronate on screw fixation in elderly female patients with pertrochanteric fractures.

Main Methods:

  • A prospective, randomized study involving sixteen female patients (age ≥ 65) with pertrochanteric fractures and a bone mineral density T-score < -2.5.
  • Patients received either weekly oral alendronate (70 mg) for three months (Group A) or no bisphosphonate therapy (Group B).
  • Fractures were stabilized with external fixators and four hydroxyapatite-coated pins; pin extraction torque was measured after three months.

Main Results:

  • No significant differences in fracture healing, loss of reduction, nonunion, or delayed union were observed between groups.
  • A statistically significant twofold increase in mean extraction torque was found for pins in cancellous bone (femoral head) in the alendronate group (2558 N/mm) compared to the control group (1171 N/mm) (p < 0.0005).
  • Extraction torque for pins in cortical bone (femoral diaphysis) showed no significant difference between the groups.

Conclusions:

  • Weekly systemic alendronate administration effectively improves pin fixation in the cancellous bone of the femoral head in elderly female patients with osteoporotic pertrochanteric fractures.
  • The observed twofold increase in extraction torque suggests enhanced implant stability in osteoporotic cancellous bone.
  • These findings support the potential use of alendronate to improve screw fixation in the femoral head for treating osteoporotic pertrochanteric fractures.