[Osteosynthesis in high-grade osteoporosis]

Operative treatment of fractures in osteoporotic bone using standard techniques such as are applied in normal bone leads to special problems. The major difficulty is the limited anchorage of any implant in osteoporotic bone. To improve the stability of an implant in osteoporotic bone the following techniques are applicable, either singly or in combination: impaction, long-distance splinting, large-area surface buttressing, osteotomy, and the use of bone cement as a spacer and to improve the purchase of screws. The different techniques are discussed and examples of their application are presented.