Abstract
Summary
The goal of our systematic literature search was to prove whether the experimentally shown influence of osteoporosis on fracture fixation could be confirmed in clinical studies. Despite significant effects in several studies, this is not supported by pooled data due to lack of accurate osteoporosis assessment and complication definitions.
Introduction
The fact that osteoporosis causes fractures is well-known; the assumption that it aggravates their orthopaedic treatment has not been proven. The goal of our systematic literature search was to find out whether the experimentally proven influence of osteoporosis on fracture fixation could be confirmed in clinical studies.
Methods
A systematic electronic database search was performed identifying articles that evaluated complications after fracture fixation among patients suspected of having osteoporosis as measured by BMD or surrogates including Singh index or risk factors. To determine complications risks (relative risk within 95% confidence interval) data were pooled across studies, weighted by sample size and stratified by treatment type.
Results
Ten studies out of 77 randomized controlled trials (51 hip, 23 distal radius and three proximal humerus studies) and three systematic reviews finally met eligibility criteria. Despite significant differences of the relative complication risk between osteoporotic and non-osteoporotic patients in several studies, this could not be proven in the pooled data.
Conclusions
In contrast to biomechanical evidence that local osteoporosis affects anchorage of implants, this could not be reproduced in clinical studies, due to the lack of accurate osteoporosis assessment, missing complication definitions and heterogeneous inclusion criteria in these studies. Prospective studies are required that address specifically the correlation between local bone status and the risk of fixation failure.
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References
Schneider E, Goldhahn J, Burckhardt P (2005) The challenge: fracture treatment in osteoporotic bone. Osteoporos Int 16(Suppl 2):S1–2
Osteoporosis Prevention, Diagnosis, and Therapy (2000) NIH Consensus Statement 17:1–36
Raisz LG (2005) Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest 115:3318–3325
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739
Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382
Chao EY, Inoue N, Koo TK, Kim YH (2004) Biomechanical considerations of fracture treatment and bone quality maintenance in elderly patients and patients with osteoporosis. Clin Orthop:12–25
Seebeck J, Goldhahn J, Stadele H, Messmer P, Morlock MM, Schneider E (2004) Effect of cortical thickness and cancellous bone density on the holding strength of internal fixator screws. J Orthop Res 22:1237–1242
Pitzen T, Franta F, Barbier D, Steudel WI (2004) Insertion torque and pullout force of rescue screws for anterior cervical plate fixation in a fatigued initial pilot hole. J Neurosurg Spine 1:198–201
Koistinen A, Santavirta SS, Kroger H, Lappalainen R (2005) Effect of bone mineral density and amorphous diamond coatings on insertion torque of bone screws. Biomaterials 26:5687–5694
Bonnaire F, Zenker H, Lill C, Weber AT, Linke B (2005) Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporos Int 16(Suppl 2):S93–S102
Dvorak MF, Pitzen T, Zhu Q, Gordon JD, Fisher CG, Oxland TR (2005) Anterior cervical plate fixation: a biomechanical study to evaluate the effects of plate design, endplate preparation, and bone mineral density. Spine 30:294–301
Fankhauser F, Schippinger G, Weber K, Heinz S, Quehenberger F, Boldin C, Bratschitsch G, Szyszkowitz R, Georg L, Friedrich A (2003) Cadaveric-biomechanical evaluation of bone-implant construct of proximal humerus fractures (Neer type 3). J Trauma 55:345–349
Knoller SM, Meyer G, Eckhardt C, Lill CA, Schneider E, Linke B (2005) Range of motion in reconstruction situations following corpectomy in the lumbar spine: a question of bone mineral density? Spine 30:E229–235
Reinhold M, Schwieger K, Goldhahn J, Linke B, Knop C, Blauth M (2006) Influence of screw positioning in a new anterior spine fixator on implant loosening in osteoporotic vertebrae. Spine 31:406–413
Yoshimine F, Latta LL, Milne EL (1993) Sliding characteristics of compression hip screws in the intertrochanteric fracture: a clinical study. J Orthop Trauma 7:348–353
Barrios C, Brostrom LA, Stark A, Walheim G (1993) Healing complications after internal fixation of trochanteric hip fractures: the prognostic value of osteoporosis. J Orthop Trauma 7:438–442
Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG (1990) Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 72:26–31
Kawaguchi S, Sawada K, Nabeta Y (1998) Cutting-out of the lag screw after internal fixation with the Asiatic gamma nail. Injury 29:47–53
Kim WY, Han CH, Park JI, Kim JY (2001) Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 25:360–362
Nordin S, Zulkifli O, Faisham WI (2001) Mechanical failure of Dynamic Hip Screw (DHS) fixation in intertrochanteric fracture of the femur. Med J Malaysia 56(Suppl D):12–17
Pankovich AM, Tarabishy IE (1980) Ender nailing of intertrochanteric and subtrochanteric fractures of the femur. J Bone Joint Surg Am 62:635–645
Spangler L, Cummings P, Tencer AF, Mueller BA, Mock C (2001) Biomechanical factors and failure of transcervical hip fracture repair. Injury 32:223–228
Weinrobe M, Stankewich CJ, Mueller B, Tencer AF (1998) Predicting the mechanical outcome of femoral neck fractures fixed with cancellous screws: an in vivo study. J Orthop Trauma 12:27–36; discussion 36–7
Heetveld MJ, Raaymakers EL, van Eck-Smit BL, van Walsum AD, Luitse JS (2005) Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome? J Bone Joint Surg Br 87:367–373
Barnett E, Nordin BE (1960) The radiological diagnosis of osteoporosis: a new approach. Clin Radiol 11:166–174
Wachter NJ, Augat P, Hoellen IP, Krischak GD, Sarkar MR, Mentzel M, Kinzl L, Claes L (2001) Predictive value of Singh index and bone mineral density measured by quantitative computed tomography in determining the local cancellous bone quality of the proximal femur. Clin Biomech 16:257–262
Koot VC, Kesselaer SM, Clevers GJ, de Hooge P, Weits T, van der Werken C (1996) Evaluation of the Singh index for measuring osteoporosis. J Bone Joint Surg Br 78:831–834
Eckstein F, Lochmuller EM, Lill CA, Kuhn V, Schneider E, Delling G, Muller R (2002) Bone strength at clinically relevant sites displays substantial heterogeneity and is best predicted from site-specific bone densitometry. J Bone Miner Res 17:162–171
Tingart MJ, Lehtinen J, Zurakowski D, Warner JJ, Apreleva M (2006) Proximal humeral fractures: regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws. J Shoulder Elbow Surg 15:620–624
Myers BS, Belmont PJ Jr., Richardson WJ, Yu JR, Harper KD, Nightingale RW (1996) The role of imaging and in situ biomechanical testing in assessing pedicle screw pull-out strength. Spine 21:1962–1968
Knop C, Lange U, Bastian L, Oeser M, Blauth M (2001) Biomechanical compression tests with a new implant for thoracolumbar vertebral body replacement. Eur Spine J 10:30–37
Ali AM, Saleh M, Eastell R, Wigderowitz CA, Rigby AS, Yang L (2006) Influence of bone quality on the strength of internal and external fixation of tibial plateau fractures. J Orthop Res 24:2080–2086
Hogh J, Lund B, Lucht U (1981) Trochanteric and subtrochanteric fractures. The operative results in a prospective and comparative study of Ender nailing and McLaughlin Osteosynthesis. Acta Orthop Scand 52:639–643
Brostrom LA, Barrios C, Kronberg M, Stark A, Walheim G (1992) Clinical features and walking ability in the early postoperative period after treatment of trochanteric hip fractures. Results with special reference to fracture type and surgical treatment. Ann Chir Gynaecol 81:66–71
Dalsgard J, Yde JR, Olsen AD (1987) [Pertrochanteric fractures. Comparison between 2 surgical methods of internal fixation]. Ugeskr Laeger 149:900–904
Chapman MW, Bowman WE, Csongradi JJ, Day LJ, Trafton PG, Bovill EG Jr (1981) The use of Ender’s pins in extracapsular fractures of the hip. J Bone Joint Surg Am 63:14–28
Liem F. In R Marti, P Dunki Jacobs (ed) Proximal femoral fractures. Operative technique and complications. Medical Press Limited, London, pp 381–388
Juhn A, Krimerman J, Mendes DG (1988) Intertrochanteric fracture of the hip. Comparison of nail-plate fixation and Ender’s nailing. Arch Orthop Trauma Surg 107:136–139
Nungu S, Olerud C, Rehnberg L (1991) Treatment of intertrochanteric fractures: comparison of Ender nails and sliding screw plates. J Orthop Trauma 5:452–457
Sernbo I, Johnell O, Gentz CF, Nilsson JA (1988) Unstable intertrochanteric fractures of the hip. Treatment with Ender pins compared with a compression hip-screw. J Bone Joint Surg Am 70:1297–1303
Adams CI, Robinson CM, Court-Brown CM, McQueen MM (2001) Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma 15:394–400
Ahrengart L, Tornkvist H, Fornander P, Thorngren KG, Pasanen L, Wahlstrom P, Honkonen S, Lindgren U (2002) A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop Relat Res:209–222
Aune AK, Ekeland A, Odegaard B, Grogaard B, Alho A (1994) Gamma nail vs compression screw for trochanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients. Acta Orthop Scand 65:127–130
Baumgaertner MR, Curtin SL, Lindskog DM (1998) Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res:87–94
Parker MJ, Handoll HH (2005) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev:CD000093
Bridle SH, Patel AD, Bircher M, Calvert PT (1991) Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br 73:330–334
Fornander P, Thorngren K-G, Tornqvist H, Ahrengart L, Lindgren U (1994) Swedish experience with the Gamma nail versus sliding hip screw in 209 randomised cases. Int J Orthp Trauma 4:118–122
Fritz T, Hiersemann K, Krieglstein C, Friedl W (1999) Prospective randomized comparison of gliding nail and gamma nail in the therapy of trochanteric fractures. Arch Orthop Trauma Surg 119:1–6
Goldhagen PR, O’Connor DR, Schwarze D, Schwartz E (1994) A prospective comparative study of the compression hip screw and the gamma nail. J Orthop Trauma 8:367–372
Guyer P, Landolt M, Keller H, Eberle C (1991) [The Gamma Nail in per- and intertrochanteric femoral fractures-alternative or supplement to the dynamic hip screw? A prospective randomized study of 100 patients with per- and intertrochanteric femoral fractures in the surgical clinic of the City Hospital of Triemli, Zurich, September 1989 - June 1990]. Aktuelle Traumatol 21:242–249
Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, Delince PE (1998) Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am 80:618–630
Harrington P, Nihal A, Singhania AK, Howell FR (2002) Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly. Injury 33:23–28
Herrera A, Domingo LJ, Calvo A, Martinez A, Cuenca J (2002) A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail. Int Orthop 26:365–369
Hoffman CW, Lynskey TG (1996) Intertrochanteric fractures of the femur: a randomized prospective comparison of the Gamma nail and the Ambi hip screw. Aust N Z J Surg 66:151–155
Hoffmann R, Schmidmaier G, Schulz R, Schutz M, Sudkamp NP (1999) [Classic nail versus DHS. A prospective randomised study of fixation of trochanteric femur fractures]. Unfallchirurg 102:182–190
\Kukla C, Heinz T, Berger G, Kwasny O, Rosenberger A, Vecsei V (1997) Gamma nail vs. dynamic hip screw in 120 patients over 60 years - a randomized trial. Acta Chirurgica Austriaca 29:290–293
Kuwabara H, Wada T, Minagi Y, Iwasaki T, Tsuji H (1998) [Compression hip screw and gamma nail for intertrochanteric fractures - Randomized prospective study]. Hokkaido Journal of Orthopaedics & Traumatology 40:29–33
Leung KS, So WS, Shen WY, Hui PW (1992) Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients. J Bone Joint Surg Br 74:345–351
Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Stromsoe K (1998) Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma 12:241–248
Marques Lopez F, Pelfort Lopez X, Barcia Casa O, Ramirez Valencia M, Leon Garcia Vao A, Ballester Soleda J (2002) Prospective, comparative, randomized study of the sliding screw and Gamma nail in the treatment of pertrochanteric fractures [Estudio prospectivo aleatorio comparativo del tornillo deslizante y el clavo gamma en el tratamiento de las fracturas pertrcantereas]. Revista de Ortopedia y Traumatologia 46:505–509
O’Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S (1995) Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw. A randomized, prospective study. Can J Surg 38:516–520
Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E (2005) Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br 87:76–81
Park SR, Kang JS, Kim HS, Lee WH, Kim YH (1998) Treatment of intertrochanteric fracture with the Gamma AP locking nail or by a compression hip screw-a randomised prospective trial. Int Orthop 22:157–160
Pelet S, Arlettaz Y, Chevalley F (2001) [Osteosynthesis of per- and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study]. Swiss Surg 7:126–133
Radford PJ, Needoff M, Webb JK (1993) A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br 75:789–793
Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P (2002) Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 16:386–393
Sadowski C, Lubbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P (2002) Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg Am 84-A:372–381
Utrilla AL, Reig JS, Munoz FM, Tufanisco CB (2005) Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma 19:229–233
Buciuto R, Hammer R (2001) RAB-plate versus sliding hip screw for unstable trochanteric hip fractures: stability of the fixation and modes of failure-radiographic analysis of 218 fractures. J Trauma 50:545–550
Davis TR, Sher JL, Checketts RG, Porter BB (1988) Intertrochanteric fractures of the femur: a prospective study comparing the use of the Kuntscher-Y nail and a sliding hip screw. Injury 19:421–426
Janzing HM, Houben BJ, Brandt SE, Chhoeurn V, Lefever S, Broos P, Reynders P, Vanderschot P (2002) The Gotfried PerCutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain. J Trauma 52:293–298
Kosygan KP, Mohan R, Newman RJ (2002) The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip. J Bone Joint Surg Br 84:19–22
Lizaur Utrilla AL, Cebrian Gomez R, Sebastia Forcada E (1998) Compression screw plate or monoblock nail-plate in trochanteric fractures of the femur in the elderly [Tornillo-placa a compresion o clavo-placa monobloque en las fracturas trocantereas del femur del anciano]. Revista de Ortopedia y Traumatologia 42:368–373
Miedel R, Ponzer S, Tornkvist H, Soderqvist A, Tidermark J (2005) The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures. A randomised, controlled trial. J Bone Joint Surg Br 87:68–75
Moroni A, Faldini C, Pegreffi F, Hoang-Kim A, Vannini F, Giannini S (2005) Dynamic hip screw compared with external fixation for treatment of osteoporotic pertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 87:753–759
Olsson O, Ceder L, Hauggaard A (2001) Femoral shortening in intertrochanteric fractures. A comparison between the Medoff sliding plate and the compression hip screw. J Bone Joint Surg Br 83:572–578
Pitsaer E, Samuel AW (1993) Functional outcome after intertrochanteric fractures of the femur: does the implant matter? A prospective study of 100 consecutive cases. Injury 24:35–36
Vossinakis IC, Badras LS (2002) The external fixator compared with the sliding hip screw for pertrochanteric fractures of the femur. J Bone Joint Surg Br 84:23–29
Lunsjo K, Ceder L, Thorngren KG, Skytting B, Tidermark J, Berntson PO, Allvin I, Norberg S, Hjalmars K, Larsson S, Knebel R, Hauggaard A, Stigsson L (2001) Extramedullary fixation of 569 unstable intertrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems. Acta Orthop Scand 72:133–140
Lunsjo K, Ceder L, Tidermark J, Hamberg P, Larsson BE, Ragnarsson B, Knebel RW, Allvin I, Hjalmars K, Norberg S, Fornander P, Hauggaard A, Stigsson L (1999) Extramedullary fixation of 107 subtrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus 3 other screw-plate systems. Acta Orthop Scand 70:459–466
Parker MJ, Handoll HH (2006) Extramedullary fixation implants and external fixators for extracapsular hip fractures in adults. Cochrane Database Syst Rev:CD000339
Schipper IB, Steyerberg EW, Castelein RM, van der Heijden FH, den Hoed PT, Kerver AJ, van Vugt AB (2004) Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br 86:86–94
Butt MS, Krikler SJ, Nafie S, Ali MS (1995) Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury 26:615–618
Dalen N, Jacobsson B, Eriksson PA (1988) A comparison of nail-plate fixation and Ender’s nailing in pertrochanteric fractures. J Trauma 28:405–406
Hayward SJ, Lowe LW, Tzevelekos S (1983) Intertrochanteric fractures: a comparison between fixation with a two-piece nail plate and Ender’s nails. Int Orthop 7:153–158
Widman J, Isacson J (2002) Primary bone grafting does not improve the results in severely displaced distal radius fractures. Int Orthop 26:20–22
McQueen MM, Hajducka C, Court-Brown CM (1996) Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br 78:404–409
Sanchez-Sotelo J, Munuera L, Madero R (2000) Treatment of fractures of the distal radius with a remodellable bone cement: a prospective, randomised study using Norian SRS. J Bone Joint Surg Br 82:856–863
McQueen MM (1998) Redisplaced unstable fractures of the distal radius. A randomised, prospective study of bridging versus non-bridging external fixation. J Bone Joint Surg Br 80:665–669
Handoll HH, Madhok R (2003) Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev:CD003209
Rodriguez-Merchan EC (1997) Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age. J Orthop Trauma 11:212–217
Young CF, Nanu AM, Checketts RG (2003) Seven-year outcome following Colles’ type distal radial fracture. A comparison of two treatment methods. J Hand Surg [Br] 28:422–426
US Food and Drug Administration - Center for Devices and Radiological Health. Norian(R) SRS(R) Cement. P970010. Issued 23–12–1998. Accessed 7/7/06
Pring DJ, Barber L, Williams DJ (1988) Bipolar fixation of fractures of the distal end of the radius: a comparative study. Injury 19:145–148
Stein H, Volpin G, Horesh Z, Hoerer D (1990) Cast or external fixation for fracture of the distal radius. A prospective study of 126 cases. Acta Orthop Scand 61:453–456
Abbaszadegan H, Jonsson U (1990) External fixation or plaster cast for severely displaced Colles’ fractures? Prospective 1-year study of 46 patients. Acta Orthop Scand 61:528–530
Howard PW, Stewart HD, Hind RE, Burke FD (1989) External fixation or plaster for severely displaced comminuted Colles’ fractures? A prospective study of anatomical and functional results. J Bone Joint Surg Br 71:68–73
Lagerstrom C, Nordgren B, Olerud C (1999) Evaluation of grip strength measurements after Colles’ fracture: a methodological study. Scand J Rehabil Med 31:49–54
Raskin KB, Melone CP Jr (1993) Unstable articular fractures of the distal radius. Comparative techniques of ligamentotaxis. Orthop Clin North Am 24:275–286
Hutchinson DT, Strenz GO, Cautilli RA (1995) Pins and plaster vs external fixation in the treatment of unstable distal radial fractures. A randomized prospective study. J Hand Surg [Br] 20:365–372
Sommerkamp TG, Seeman M, Silliman J, Jones A, Patterson S, Walker J, Semmler M, Browne R, Ezaki M (1994) Dynamic external fixation of unstable fractures of the distal part of the radius. A prospective, randomized comparison with static external fixation. J Bone Joint Surg Am 76:1149–1161
Horne JG, Devane P, Purdie G (1990) A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radial fractures. J Orthop Trauma 4:30–34
Merchan EC, Breton AF, Galindo E, Peinado JF, Beltran J (1992) Plaster cast versus Clyburn external fixation for fractures of the distal radius in patients under 45 years of age. Orthop Rev 21:1203–1209
Lenoble E, Dumontier C, Goutallier D, Apoil A (1995) Fracture of the distal radius. A prospective comparison between trans-styloid and Kapandji fixations. J Bone Joint Surg Br 77:562–567
Gupta R, Raheja A, Modi U (1999) Colles’ fracture: management by percutaneous crossed-pin fixation versus plaster of Paris cast immobilization. Orthopedics 22:680–682
Shankar NS, Craxford AD (1992) Comminuted Colles’ fractures: a prospective trial of management. J R Coll Surg Edinb 37:199–202
Fikry T, Fadili M, Harfaoui A, Dkhissi M, Zryouil B (1998) [Metaphysis fracture of the distal radius: Kapandji’s or Py’s pinning?]. Ann Chir Main Memb Super 17:31–40
Schmalholz A (1989) Bone cement for redislocated Colles’ fracture. A prospective comparison with closed treatment. Acta Orthop Scand 60:212–217
Kapoor H, Agarwal A, Dhaon BK (2000) Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury 31:75–79
Rommens PM, Heyvaert G (1993) [Conservative treatment of subcapital humerus fractures. A comparative study of the classical Desault bandage and the new Gilchrist bandage]. Unfallchirurgie 19:114–118
Zyto K, Ahrengart L, Sperber A, Tornkvist H (1997) Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 79:412–417
Kristiansen B, Kofoed H (1988) Transcutaneous reduction and external fixation of displaced fractures of the proximal humerus. A controlled clinical trial. J Bone Joint Surg Br 70:821–824
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The study was funded by the AO Clinical Priority Program “Fracture fixation in osteoporotic bone.”
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Goldhahn, J., Suhm, N., Goldhahn, S. et al. Influence of osteoporosis on fracture fixation - a systematic literature review. Osteoporos Int 19, 761–772 (2008). https://doi.org/10.1007/s00198-007-0515-9
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DOI: https://doi.org/10.1007/s00198-007-0515-9