The challenge of fracture management in osteoporotic bones
Objective: To determine the types of fractures encountered in osteoporotic patients and assess the functional outcome of these fractures. Also suggest change of their management and to suggest preventive interventions. Design: A retrospective analytical 10 years study between 1998 and 2007. Setting: The patients were treated at three private hospitals in Nairobi, Kenya. Patients and methods: Consecutive files of traceable patients who were treated for osteoporotic fractures from January 1998 to December 2007. The demographic data, investigations, management methods and functional outcomes of the treatment were determined. The data collected was analysed using SPSS 17.0 windows. Results: Sixty patients were available for review. Forty five were females while 15 were males, giving a F:M ration of 3:1. There were 14 vertebral fractures, 15 hip fractures (5 neck fractures intra-capsular) and 10 extra capsular)., 5 fractures of the distal wrist and 8 humeral fractures, 4 rib fractures, 6 pelvic fractures, 2 sternal fractures and 6 tibial fractures. Twenty six (40%) of the above fractures namely the vertebral, ribs, pelvis and sternum were treated conservatively while 34 fractures (60%) were treated by various methods of internal fixation. All were old patients aged 60 to 101 years (Mean 75 years.) The overall results of the surgery was unsatisfactory in 13(38%) due to metal pull out, screw loosening, periprosthetic fractures, none union seen in patients of hip, humerus, tibia fractures. Twenty one patients (62%) had good outcome. Conclusion: Osteoporotic fractures are a challenge to orthopaedic and trauma surgeons due to unpredictable results of surgery in the elderly patients. Recommendations: It is suggested to make awareness among health workers especially the orthopaedic and trauma surgeons, nurses and physiotherapists so as to put preventive measures in place. As regards operative management careful planning as team work and use of newer techniques, pharmaceuticals like diphosphonates to assist in fracture healing and use of augmentation techniques is worthwhile considering. Kenya Orthopaedic Association (K.O.A) formulate a policy for management of osteoporotic fractures in our local set up.