Abstract
Osteoporotic fractures are challenging to treat, as poor bone strength can prevent fixation devices from firmly holding bone tissue in position during surgery and subsequent recovery. Surgeons are more likely to achieve maximal stability of such fractures if they understand the changes to bone strength and morphology that occur due to osteoporosis as well as the biomechanical principles that underlie the designs of commonly used fracture fixation devices. We discuss both topics in the following chapter, which provides an in-depth analysis of the principles of load-bearing and load-sharing in fractures fixed with either plates or intramedullary nails. The objective of this chapter is to aid in the development of surgical strategies for enhancing fracture fixation in osteoporotic bone tissue.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Burstein AH, Reilly DT, Martens M. Aging of bone tissue: mechanical properties. J Bone Joint Surg Am. 1976;58(1):82–6.
Crowninshield RD, Pope MH. The response of compact bone in tension at various strain rates. Ann Biomed Eng. 1974;2(2):217–25.
Currey JD. The effects of strain rate, reconstruction and mineral content on some mechanical properties of bovine bone. J Biomech. 1975;8(1):81–6.
McElhaney JH. Dynamic response of bone and muscle tissue. J Appl Physiol. 1966;21(4):1231–6.
Merk BR, Stern SH, Cordes S, Lautenschlager EP. A fatigue life analysis of small fragment screws. J Orthop Trauma. 2001;15(7):494–9.
Currey JD, Butler G. The mechanical properties of bone tissue in children. J Bone Joint Surg Am. 1975;57(6):810–4.
Weaver JK, Chalmers J. Cancellous bone: its strength and changes with aging and an evaluation of some methods for measuring its mineral content: I. Age changes in cancellous bone. JBJS. 1966;48(2):289–99.
Currey JD. Changes in the impact energy absorption of bone with age. J Biomech. 1979;12(6):459–69.
Bartley MH Jr, Arnold JS, Haslam RK, Jee WSS. The relationship of bone strength and bone quantity in health, disease and aging 12. J Gerontol. 1966;21(4):517–21.
Bell GH, Dunbar O, Beck JS, Gibb A. Variations in strength of vertebrae with age and their relation to osteoporosis. Calcif Tissue Res. 1967;1(1):75–86.
Cody DD, Goldstein SA, Flynn MJ, Brown EB. Correlations between vertebral regional bone mineral density (rBMD) and whole bone fracture load. Spine. 1991;16(2):146–54.
Galante J, Rostoker W, Ray RD. Physical properties of trabecular bone. Calcif Tissue Res. 1970;5(1):236–46.
Carter DR, Hayes WC. The compressive behavior of bone as a two-phase porous structure. J Bone Joint Surg Am. 1977;59(7):954–62.
Frigg R, Appenzeller A, Christensen R, Frenk A, Gilbert S, Schavan R. The development of the distal femur less invasive stabilization system (LISS). Injury. 2001;32:24–31.
Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18(8):488–93.
Ellis T, Bourgeault CA, Kyle RF. Screw position affects dynamic compression plate strain in an in vitro fracture model. J Orthop Trauma. 2001;15(5):333–7.
Sanders R, Haidukewych GJ, Milne T, Dennis J, Latta LL. Minimal versus maximal plate fixation techniques of the ulna: the biomechanical effect of number of screws and plate length. J Orthop Trauma. 2002;16(3):166–71.
ElMaraghy AW, ElMaraghy MW, Nousiainen M, Richards RR, Schemitsch EH. Influence of the number of cortices on the stiffness of plate fixation of diaphyseal fractures. J Orthop Trauma. 2001;15(3):186–91.
Hou S-M, Wang J-L, Lin J. Mechanical strength, fatigue life, and failure analysis of two prototypes and five conventional tibial locking screws. J Orthop Trauma. 2002;16(10):701–8.
Yee DKH, Lau W, Tiu KL, Leung F, Fang E, Pineda JPS, et al. Cementation: for better or worse? Interim results of a multi-centre cohort study using a fenestrated spiral blade cephalomedullary device for pertrochanteric fractures in the elderly. Arch Orthop Trauma Surg. 2020;140(12):1957–64.
Roberts TT, Prummer CM, Papaliodis DN, Uhl RL, Wagner TA. History of the orthopedic screw. Orthopedics. 2013;36:12–4.
Stahel PF, Alfonso NA, Henderson C, Baldini T. Introducing the “bone-screw-fastener” for improved screw fixation in orthopedic surgery: a revolutionary paradigm shift? Patient Saf Surg. 2017;11:6.
Feng X, Lin G, Fang CX, et al. Bone resorption triggered by high radial stress: the mechanism of screw loosening in plate fixation of long bone fractures. J Orthop Res. 2019;37:1498–507.
Feng X, Qi W, Zhang T, et al. Lateral migration resistance of screw is essential in evaluating bone screw stability of plate fixation. Sci Rep. 2021;11:12510.
Feng X, Qi W, Fang CX, et al. Can barb thread design improve the pullout strength of bone screws? A biomechanical study and finite element analysis. Bone Joint Res. 2021;10:105–12.
Feng X, Zhang S, Liang H, Chen B, Leung F. Development and initial validation of a novel undercut thread design for locking screws. Injury. 2022;53(7):2533–40. https://doi.org/10.1016/j.injury.2022.02.048.
Feng X, Zhang S, Luo Z, Liang H, Chen B, Leung F. Development and initial validation of a novel thread design for non-locking cancellous screws. J Orthop Res. 2022;40(12):2813–21. https://doi.org/10.1002/jor.25305.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Feng, X., Leung, F., Kulper, S., Ueda, E. (2024). Biomechanics of Osteoporotic Fracture Fixation. In: Leung, F., Lau, T.W. (eds) Surgery for Osteoporotic Fractures. Springer, Singapore. https://doi.org/10.1007/978-981-99-9696-4_2
Download citation
DOI: https://doi.org/10.1007/978-981-99-9696-4_2
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-99-9695-7
Online ISBN: 978-981-99-9696-4
eBook Packages: MedicineMedicine (R0)