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27 February 2008

The impact of osteoporosis on the classification of hip and wrist fractures

Laszlo M. HoeselBCDEF, Michael PauschBCD, Reinhard SchnettlerAG, Christian HeissAFG

Med Sci Monit 2008; 14(3): HY1-8 :: ID: 836564

Abstract

Background
Previous studies demonstrated a correlation between bone density, stability of fracture fixation, and outcome. Because current fracture classifications do not take osteoporosis into account, a prospective radiological analysis was conducted of patients with hip and wrist fracture to evaluate the impact of osteoporosis on fracture classification.
Material and Method
Altogether, 77 consecutive patients with either hip or wrist fracture were prospectively recruited within 24 hours of sustaining the fracture. The patients were assigned to subgroups according to gender, fracture site, fracture type, and bone mineral density (BMD). Using widely accepted classification systems for hip and wrist fractures, the impact of osteoporosis on fracture classification was assessed.
Results
Osteoporosis dominated in both fracture types and bone mineral density showed a significant negative correlation with age. Pertrochanteric fractures were more frequent, showing an equal distribution among severity grades, while less frequent femoral neck fractures were mainly unstable fractures. Postmenopausal patients sustained more severe intraarticular comminuted wrist fractures, which were not found using the Fernandez classification.
Conclusions
The contradiction between the higher incidence but lower severity of pertrochanteric fractures compared with femoral neck fractures in osteoporotic bone and inconsistencies between the classifications of wrist fractures may indicate incomplete fracture classification in osteoporosis. Given the high incidence of osteoporotic fractures, incorporating bone mineral status into fracture classification systems may improve preoperative assessment, implant stability, and outcome.

Keywords: Prospective Studies, Osteoporosis, Postmenopausal, Osteoporosis, Hip Fractures - classification, Wrist Injuries - classification, Bone Density, Aged, 80 and over, Adult

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