Journal of orthopaedic trauma
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Periprosthetic fractures are fractures that occur in association with an orthopaedic implant, most often used for joint arthroplasty or fracture fixation. They are associated with significant morbidity and increased mortality in some cases. ⋯ Implant, surgeon, and patient factors all contribute to the risk of periprosthetic fracture. In this review, we intend to discuss current trends in periprosthetic fractures and risk factors associated with their development in the joint arthroplasty and fracture patient.
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Multiple trauma in the elderly is increasing with the aging population. In contrast to their younger counterparts, elderly patients experience significantly higher mortality rates and complications after major trauma. Diminished physiological reserve and the existence of multiple medical comorbidities present additional challenges to management. As such, a different approach is required to care for the elderly trauma patient.
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Osteoporotic fractures present a number of significant challenges for surgical management, including high degrees of fracture comminution, poor implant fixation secondary to inferior bone quality, and compromised capacity for fracture healing. Osteobiologics are materials/agents that can promote fracture healing and enhance fracture stability. ⋯ Despite this, limited clinical investigation into the use of osteobiologics in the management of osteoporotic fractures has been performed. This article reviews a select number of osteobiologic products and the evidence for their use in osteoporotic fractures.
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Typical posterior pelvic fixation constructs use one or more large screws inserted from the lateral iliac cortex into the safe upper sacral ala or body. As a result of the deforming forces acting perpendicular to the implant axis, routine iliosacral screw fixation may not provide adequate stabilization, especially in certain unstable injuries. ⋯ These screws require careful preoperative planning and more precise technical attention during insertion because they pass through both sacral alar zones. Transiliac-transsacral screws may be particularly useful in the presence of osteoporosis, significant posterior pelvic instability including spinopelvic dissociation, patient obesity, anticipated noncompliant behavior, bilateral posterior pelvic injuries, and nonunion procedures.