Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
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Fractures of the distal humerus are difficult to treat. In elderly patients, diminished bone mineral quality and increased trauma-associated joint destruction may make stable joint reconstruction even more problematic. Furthermore, comorbidities and poor tolerance of joint immobilization might be additional factors which influence elbow function negatively. Until now, disagreement has existed on how to treat these fractures in elderly patients. Recommendations range from conservative treatment to primary total elbow replacement. So far, reports in the literature on whether or not open reduction and internal fixation in these patients is justified are very rare. ⋯ Open reduction and internal fixation of distal humerus fractures in elderly patients should be the main goal, since good elbow function can be achieved in the majority of patients. Elbow immobilization longer than 14 days should be avoided. Stable implant anchorage at the lateral column remains problematic, reflecting a general potential for further implant improvements.
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The mechanical behavior of trabecular bone depends on the internal bone structure. It is generally accepted now that the trabecular bone structure is a result of a load adaptive bone remodeling. The mathematical laws that relate bone remodeling to the local state of stress and strain, however, are still under investigation. ⋯ Right after the onset of menopause, bone was lost fast, where with the progression of age losses slowed down. The structures at the end-point of the simulations were then compared qualitatively and quantitatively to the structures of the post-menopausal group with all morphometric indices being within a narrow margin of error. These results suggest the feasibility of transforming "normal" to "osteopenic" bone on a microstructural level yielding in realistic bone models similar in appearance as well as in structural behavior if compared to a post-menopausal group of women.