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The bone plate fixation techniques for patients with osteoporosis mainly include the following aspects:
Select the appropriate internal fixation material:
Reconstruction steel plate: It is easy to shape and can fully adhere to the shape of the fixed bone. Even if the steel plate has a certain degree of poor shaping during the operation, it can slightly shape itself to adapt to the shape of the bone when the screws are tightened. Clinically, 3.5mm reconstruction plates are generally recommended. 4.5mm plates are only used for patients with thick bones and osteoporosis, as well as for the fixation of the posterior sacral and adjacent sacroiliac joints.
Hook plates or elastic plates: In weak bone areas such as the posterior part of the pelvis and the acetabular wall, especially when fractures are comminuted and osteoporosis exists, the addition of hook plates or elastic plates can significantly increase the mechanical stability of internal fixation.
Improved screw fixation technology
The largest screw diameter and length are adopted to increase the strength of screw fixation within the osteoporotic bone. However, choosing thicker and longer screws can easily lead to perforation of the side walls or protrusion at the top, so it is necessary to operate with caution.
Replace the steel plate fixation:
Theoretically, the use of larger and longer steel plates combined with screws of corresponding diameters for fixation can increase the fixation strength of the osteoporotic cement-internal fixation complex. However, attention should be paid to the problems brought about by the increase in the outer diameter of the screw, such as a significant decrease in the screw’s ability to squeeze into the screw hole, and the risk that thick screws may penetrate the hip joint when used around the acetabulum.
Internal fixation with cable wire or steel wire:
For osteoporotic bones, stainless steel wire of grade 16 or 18 or double-strand steel wire with a diameter of 2mm is particularly effective. The adoption of minimally invasive wire threading technology can reduce the damage to bone blood supply and lower the chances of postoperative infection and osteonecrosis.
Application of locking steel plates:
Locking plates emphasize “biological fixation”, allowing for indirect reduction, minimally invasive treatment, preservation of bone blood supply and fracture hematoma, and enabling micro-movement at the fracture site to stimulate callus formation. It provides angular stability, resistance to bending and torsion, and is especially suitable for osteoporotic fractures.
The locking screw head is conical in shape, which improves the mechanical distribution, provides a radial preload, and prevents bone resorption and screw loosening.
Surgical techniques and precautions:
Preoperative planning: A formal preoperative plan can ensure that the surgeon prepares all necessary implants in advance.
Screw placement: The sequence of screw placement, the length and position of the steel plate, and the surgical approach are all crucial for the success of the operation.
Fracture reduction: Since locking screws cannot pull the plate towards the bone end like traditional screws, fracture reduction with locking plates is quite challenging. The surgeon needs to carefully use the specially designed reduction forceps to percutaneous reduce the long bones and bone blocks around the joints.
Stress dispersion: When using bridge plates to fix comminuted fractures, at least 3 to 4 screw holes should be left around the fracture line to obtain a larger stress dispersion area.