Bone Mineral Quality Research Articles

Novel ultrasound assisted suture anchor system using the BoneWelding® technology yields a comparable primary stability in osteopenic and healthy human humeri as a benchmark anchor

IntroductionThe aim of this biomechanical study was to evaluate the primary stability of the SportWelding® Sombrero 3.6 mm suture anchor system in osteopenic and healthy cadaveric humeri. MethodsThe Sombrero® and BioCorkscrew® anchors were deployed in 8 osteopenic and 4 healthy cadaver humeri after the bone mineral density (BMD) measurements of the 32 specimens. Both anchors were loaded with a USP Nr. 2 FiberWire® suture. An established cyclic testing protocol was performed. The maximum failure load (Fmax), the system displacement and the modes of failure were recorded. ResultsThe Fmax and system displacement of the Sombrero® in osteopenic and healthy humeri was equivalent to the Bio-Corkscrew® benchmark anchor; there were no significant differences in the maximum failure loads and system displacement values. Only anchor and suture dislocations were observed; suture ruptures did not occur. ConclusionThis study shows that the Sombrero® yields similar maximum failure loads and system displacement values as the established Bio-Corkscrew® benchmark anchor. The primary stability of the Sombrero® and Bio-Corkscrew® seems to be independent of the bone mineral quality. This relatively small-sized polymer anchor is independent of the BMD and may be an alternative to established suture anchors in rotator cuff repair.

Bone mineral density and quality, body composition of women in postmenopausal period

Bone mineral density and quality, body composition of women in postmenopausal period

The impact of primary hyperparathyroidism and its treatment on bone mineral density, bone mineral parameters, insulin resistance, body composition and quality of life - A prospective pilot study from India

The impact of primary hyperparathyroidism and its treatment on bone mineral density, bone mineral parameters, insulin resistance, body composition and quality of life - A prospective pilot study from India

Rural-Urban Differences of Dietary Patterns, Overweight, and Bone Mineral Status in Chinese Students.

China is an urban and rural social model country. In the past three decades, the developing speed of rural areas has been much slower than urban areas, which may lead to the differences in dietary patterns. This study aimed to investigate the disparities of dietary structures from urban and rural children, and to analyze the effects of different dietary patterns on their adverse outcome. Among 1590 students, aged 11 years to 17 years, from primary and middle schools, a cross-sectional study was conducted. There were three dietary patterns recognized: Westernization structure, meat diet structure, and Western and Chinese structure. Compared with rural students, more urban students were in the highest categories of the whole dietary patterns (p < 0.001). Overweight/obesity and central adiposity were more prevailing among urban students, while rural students had a more prevailing risk of bone fracture (p < 0.05). Through the adjustment for all confounding factors, the Westernization structure could increase the risk of overweight/obesity and central adiposity, the meat structure could increase the risk of elevated blood pressure/hypertension, while the risk of low bone mineral quality could be reduced by the Chinese and Western structure. In conclusion, a rural-urban disparity in dietary patterns was found in our study, and different dietary patterns were associated with the risk of some adverse outcomes. Therefore, there were different prevalences of the adverse outcomes between rural and urban students.

Locking plates in distal humerus fractures: study of 43 patients

ObjectiveThe treatment of multi-fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal humerus fractures. MethodsForty-three consecutive patients with articular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score. ResultsForty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years (18-73 years). Clinical and radiological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks). The average follow-up was 12 months (10-18 months). Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5%). One patient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. ConclusionAnatomically preshaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early post-operative rehabilitation. The low rate of implant failure in the present study indicates that the technique is promising and warrants further investigation.

The Effects of Circuit Training on Bone Mineral Density, Physical Fitness, and Quality of Life in Postmenopausal Osteopenic Women

The Effects of Circuit Training on Bone Mineral Density, Physical Fitness, and Quality of Life in Postmenopausal Osteopenic Women

Strontium does not affect the intrinsic bone quality at tissue and BSU levels in iliac samples from Macaca fascicularis monkeys

Our purpose was to evaluate the impact of strontium ranelate (SrRan) on bone mineral quality at both tissue and bone structural unit (BSU) levels. Thirty iliac bone samples (dehydrated then embedded) were taken from monkeys who received 0 (controls), 200, 500 or 1250mg/kg/day of SrRan for 52weeks and were sacrificed either at the end of administration (treated animals, n=16) or 10weeks later (reverse animals, n=14). Degree of mineralization (DMB), heterogeneity index of mineralization (HI), Vickers microhardness (Hv) and focal bone strontium content (BSC) were measured globally at tissue level and focally on the same 923 BSUs. Mineral and collagen characteristics, as well as chemometric analyses were performed on younger and older tissues in cortical bone and cancellous bone in 737 other BSUs. At tissue level, SrRan preserved material properties. At BSU level, BSC increased (significant) dose dependently in treated and reverse animals. DMB and Hv were greater in older than in younger bone in controls and treated animals. In treated animals, DMB was positively correlated with Hv and inversely correlated with the BSC. Thus, younger BSUs were less mineralized and less hard than older BSUs independently from the presence of strontium. Mineral maturity, crystallinity index, mineralization index, carbonation and collagen maturity were not modified by SrRan. Chemometry confirmed the absence of a direct effect of strontium on mineralization. Thus, surrogates of micro- and nano-structural mineral properties were not altered by SrRan and remained at a physiological level.

Raman spectroscopy demonstrates Amifostine induced preservation of bone mineralization patterns in the irradiated murine mandible

PurposeAdjuvant radiotherapy in the management of head and neck cancer remains severely debilitating. Fortunately, newly developed agents aimed at decreasing radiation-induced damage have shown great promise. Amifostine (AMF) is a compound, which confers radio-protection to the exposed normal tissues, such as bone. Our intent is to utilize Raman spectroscopy to demonstrate how AMF preserves the mineral composition of the murine mandible following human equivalent radiation. MethodsSprague Dawley rats were randomized into 3 experimental groups: control (n=5), XRT (n=5), and AMF–XRT (n=5). Both XRT and AMF groups underwent bioequivalent radiation of 70Gy in 5 fractions to the left hemimandible. AMF–XRT received Amifostine prior to radiation. Fifty-six days post-radiation, the hemimandibles were harvested, and Raman spectra were taken in the region of interest spanning 2mm behind the last molar. Bone mineral and matrix-specific Raman bands were analyzed using one-way ANOVA, with statistical significance at p<0.05. ResultsThe full-width at half-maximum of the primary phosphate band (FWHM) and the ratio of carbonate/phosphate intensities demonstrated significant differences between AMF–XRT versus XRT (p<0.01) and XRT versus control (p<0.01). There was no difference between AMF–XRT and control (p>0.05) in both Raman metrics. Computer‐aided spectral subtraction further confirmed these results where AMF–XRT was spectrally similar to the control. Interestingly, the collagen cross-link ratio did not differ between XRT and AMF–XRT (p<0.01) but was significantly different from the control (p<0.01). ConclusionOur novel findings demonstrate that AMF prophylaxis maintains and protects bone mineral quality in the setting of radiation. Raman spectroscopy is an emerging and exceptionally attractive clinical translational technology to investigate and monitor both the destructive effects of radiation and the therapeutic remediation of AMF on the structural, physical and chemical qualities of bone.

Reduction of volumetric bone mineral density in postmenopausal women with hepatitis C virus-correlated chronic liver disease: A peripheral quantitative computed tomography (pQCT) study

BackgroundThe prevalence of osteoporosis in chronic liver disease (CLD) varies considerably among the studies, depending on patient selection and diagnostic criteria. We aimed to measure bone turnover markers and volumetric bone mineral density (BMD) in a group of postmenopausal women with CLD using both dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), in comparison with age-matched healthy subjects. MethodsThirty-five postmenopausal patients with HCV-correlated CLD and 35 healthy postmenopausal women, as controls, underwent a DXA scan at lumbar and femoral level and a pQCT measurement of the nondominant forearm. Serum concentrations of biochemical markers relevant to bone turnover were also measured. ResultsPatients showed no differences in DXA values either at lumbar or femoral level compared to controls. On the contrary, pQCT geometrical (cortical cross-sectional area) and volumetric (total and trabecular volumetric BMD) parameters were significantly reduced in the CLD women. Also the Strength–Strain Index (SSI), an estimate of diaphyseal bone resistance to bending and torsion, was significantly lower in patients than in controls. Patients with CLD presented an unbalanced bone turnover, with increased bone resorption markers. ConclusionsThe bone geometrical and volumetric parameters measured in our CLD postmenopausal women, by pQCT, show a reduced bone mineral quality and stiffness. Conversely, DXA-measurements seem unable to appreciate the bone alterations in these patients. This would encourage further studies to validate pQCT analysis as a diagnostic tool for a correct estimate of bone involvement in CLD.

Bone quality and strontium ranelate

Given its increasing incidence and serious complications, osteoporosis requires safe and effective longterm treatment. Strontium ranelate is an osteoporosis treatment with a broad spectrum of safety and efficacy in reducing the risks of both vertebral and nonvertebral (including hip) fractures in a wide variety of patients. This treatment should be considered as a first-line option to treat women at risk of osteoporotic fractures, whatever their age, the severity of the disease and their risk factors. The analysis of transiliac bone biopsies has provided further evidence of the good bone tissue safety of strontium ranelate. Results are fully consistent with the mode of action of strontium ranelate involving dissociation between bone formation and bone resorption. Strontium ranelate treatment appears to stimulate both trabecular and cortical bone formation in 3D analyses, but without increasing cortical porosity. The change in 3D trabecular and cortical microarchitecture may improve bone biomechanical competence and explain the decreased fracture rate after treatment. We now have evidence that strontium (Sr) is heterogeneously distributed in bone tissue and is exclusively present in bone formed after the beginning of treatment. Sr is absent from old bone formed before treatment, but focal bone Sr content is constant during treatment. Whatever the duration of treatment and the content of Sr in bone, the variables reflecting secondary mineralization at the tissue level are maintained at normal levels. However, the influence of Sr on the quality of bone mineral and its mineralization remains to be clarified. IBMS BoneKEy. 2010 March;7(3):103-107. ©2010 International Bone & Mineral Society

In osteoporotic women treated with strontium ranelate, strontium is located in bone formed during treatment with a maintained degree of mineralization

In postmenopausal osteoporotic women and up to 3 years of treatment with strontium ranelate, strontium was present only in recently deposited bone tissue resulting from formation activity during the period of treatment. Strontium was shown to be dose-dependently deposited into this newly formed bone with preservation of the mineralization. Interactions between strontium (Sr) and bone mineral and its effects on mineralization were investigated in women treated with strontium ranelate. Bone biopsies from osteoporotic women were obtained over 5-year strontium ranelate treatment from phases II and III studies. Bone samples obtained over 3-year treatment were investigated by X-ray microanalysis for bone Sr uptake and focal distribution, and by quantitative microradiography for degree of mineralization. On some samples, Sr distribution (X-ray cartography) was analyzed on whole sample surfaces and the percentage of bone surface containing Sr was calculated. Bone Sr content was chemically measured on whole samples. In treated women, Sr was exclusively present in bone formed during treatment; Sr deposition depended on the dose with higher focal content in new bone structural units than in old ones constantly devoid of Sr, even after 3-year treatment. A plateau in global bone Sr content was reached after 3 years of treatment. Cartography illustrated the extent of surfaces containing Sr, and formation activity during strontium ranelate treatment was higher in cancellous than in cortical bone. Mineralization was maintained during treatment. The quality of bone mineral was preserved after treatment with strontium ranelate, supporting the safety of this agent at the bone tissue level.

Alterations of ovariectomized rat bone and impact of non-collagenous proteins on mineralization

Objectives Noncollagenous proteins (NCPs) play distinct and overlap roles in controlling the mineralization of bone, while the relationship between the NCPs and the mineral phase in osteoporotic bone is nebulous. Ovariectomized (OVX) rats, as an animal model for osteopenia, were used in this study to evaluate the impact of NCPs on mineral metabolism in osteopenia development. Methods Bone mineral was characterized with small-angle X-ray scattering study, extended X-ray absorption fine structure analysis, inductively coupled plasma mass spectroscopy, thermogravimetric and chemical analyses. NCPs were extracted from bone matrix, and analyzed with sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS–PAGE). A constant composition titration system was used in the kinetic study of re-mineralization of bone residues after various extractions. Results Bone density was reduced, whereas no significant changes were observed in the composition, crystal thickness and crystal structural parameters of minerals from OVX rat bone. The total content of NCPs in each extract decreased in the OVX group, but no selective loss of particular proteins was observed. The difference in mineralization kinetics between the OVX rat bone and the sham rat bone was resulted mainly from the mineral-bound NCPs. Conclusions The reduced quantity and unchanged quality of bone mineral seem to be positively associated with the total amount of NCPs and the proportions between some major NCPs in OVX rats, respectively.

News &amp; Notes

AbstractCervical cancer risk falls when OCs stoppedThe increased risk of cervical cancer associated with oral contraceptives (OCs) declines after use ends and returns to baseline after 10 years, Cancer Research UK has shown (Lancet 2007; 370: 1609‐21).The new analysis pooled data from 24 studies involving a total of 16 573 cases and 35 509 controls. In women up to 50 years old in developed countries, OC use was associated with a higher incidence of cervical cancer, increased from 3.8/1000 among never‐users to 4.0/1000 after 5 years and 4.5/1000 after 10 years. This was the first study to show that the risk decreased when OC use ended, with similar risks between patient subgroups.Little evidence comparing osteoporosis treatmentsWhile there is good evidence that the bisphosphonates and other therapies are effective in the treatment of osteoporosis, few comparative data are available and their relative efficacy is uncertain, say US analysts (Ann Intern Med 2008; 148(3); published online 18 Dec 2007).Their systematic review of 75 randomised trials and 24 metaanalyses found good evidence that bisphosphonates, oestrogen, parathyroid hormone and raloxifene reduced vertebral fracture risk compared with placebo, and fair evidence for calcitonin. For hip fractures, there was good evidence for the efficacy of oestrogen, alendronate and risedronate, and fair evidence supporting zoledronic acid; the efficacy of vitamin D varied with the analogue, dose and study population.A larger database provided safety data: raloxifene and oestrogens (alone or combined) increased the risk of thrombosis and etidronate increased the risk of oesophageal ulceration and gastrointestinal perforations, ulcerations and bleeding.Bevacizumab delays progression of metastatic breast cancerInitial treatment of metastatic breast cancer with a combination of bevacizumab and paclitaxel increases progression‐free survival but not overall survival, a new study shows (N Eng J Med 2007; 357: 2666‐76).Among 722 women who received 4‐weekly cycles, median progression‐free survival was 11.8 months with combination therapy compared with 5.9 months with paclitaxel alone. Although one‐year survival was higher with combination therapy (81.2 vs 73.4 per cent), median survival was similar in the two groups (26.7 vs 25.2 months). Combined therapy was associated with a higher incidence of hypertension, proteinuria and cerebrovascular ischaemia.Testosterone has mixed effects in older menTestosterone supplementation in older men with low testosterone levels (&lt;13.7nmol/l) does not improve cognition or functional status, according to investigators from The Netherlands (JAMA 2008; 299: 39‐52).Six months' treatment with testosterone undecanoate 80mg twice daily increased lean body mass, decreased fat mass and improved insulin sensitivity compared with placebo.However, high‐density lipoprotein‐cholesterol was decreased and the prevalence of metabolic syndrome was higher than with placebo (48 vs 36 per cent, P=0.07). There was no effect on quality of life, prostate safety or bone mineral density.Information for people undergoing gender changeThe Department of Health has published information resources for people undergoing gender change, their families and healthcare staff.The leaflet Transgender experiences – information and support explains gender dysphoria and its treatment, individuals' rights and choices and sources of support. A guide to hormone therapy for trans people is a booklet explaining treatment in detail. Both can be downloaded from the Department of Health website (www.dh.gov.uk). Copyright © 2008 Wiley Interface Ltd.

Precision of Lunar Achilles+ bone quality measurements: time dependency and multiple machine use in field studies

Qualitative ultrasound (QUS) is a portable, safe and relatively inexpensive technique used to obtain information on bone mineral quality in adults and children. QUS measures bone stiffness index (SI) through the incorporation of speed of sound (SOS) and broadband ultrasound attenuation (BUA). QUS technology may prove to be extremely useful in field research where more than one machine is used over different periods of time. 13 adults (27.6+/-4.6 years old) were recruited to determine the internal stability of two Lunar Achilles+ QUS machines (Lunar1, Lunar2), as well as the repeatability in bone stiffness measures between the two machines over time. Triplicate measurements of the calcaneus were taken within the same day (n = 258) and at 1 week (n = 120), 6 months (n = 54) and 1 year (n = 18) apart to determine the time-dependent repeatability. Using paired t-tests and separate mixed effects models, there were no differences reported in SI, SOS or BUA values within one machine, or between two machines over these short- and long-term time-frames. These results indicate that QUS machines are internally consistent and different machines may be used over time to provide reliable measurements of changes in bone quality.

Accretion of Bone Quantity and Quality in the Developing Mouse Skeleton

In this work, we found that bone mineral formation proceeded very rapidly in mice by 1 day of age, where the degree of mineralization, the tissue mineral density, and the mineral crystallinity reached 36%, 51%, and 87% of the adult values, respectively. However, even though significant mineralization had occurred, the elastic modulus of 1-day-old bone was only 14% of its adult value, indicating that the intrinsic stiffening of the bone lags considerably behind the initial mineral formation. To meet the mechanical challenges during early development, the skeleton requires the rapid accretion of bone quality and bone quantity. Here, we describe early bone development in the mouse skeleton and test the hypothesis that specific compositional properties determine the stiffness of the tissue. Tibias of female BALB mice were harvested at eight time-points (n = 4 each) distributed between 1 and 40 days of age and subjected to morphometric (muCT), chemical (Fourier transform infrared microspectroscopy), and mechanical (nanoindentation) analyses. Tibias of 450-day-old mice served as fully mineralized control specimens. Bone growth proceeded very rapidly; at 1 day of age, the degree of mineralization (phosphate/protein ratio), the density of mineralized bone (TMD), and mineral crystallinity had reached 36%, 51%, and 87% of the adult (450 days) values, respectively. Spatially, the variability in mineralization across the mid-diaphysis was very high for the early time-points and declined over time. In contrast to the notable changes in mineralization, carbonate substitution into the mineral lattice (carbonate/phosphate ratio) and collagen cross-linking did not show any significant changes over this time period. Even though significant mineralization had occurred, the elastic modulus of 1-day-old bone was only 14% of the adult value and increased to 89% (of its adult value) after 40 days. Between samples of different time-points, significant positive correlations were observed between the elastic modulus and TMD (r(2) = 0.84), phosphate/protein ratio (r(2) = 0.59), and crystallinity (r(2) = 0.23), whereas collagen cross-linking showed a small but significant negative correlation (r(2) = 0.15). These data indicate that specific chemical and morphometric properties modulate bone's stiffness during early growth. The intrinsic stiffening of the bone, however, lags considerably behind the initial mineral formation, emphasizing the importance of bone mineral quality for optimizing matrix integrity.

HIV-associated osteopenia and osteoporosis

Purpose of review: Highly active antiretroviral therapy has radically changed the course of human immunodeficiency virus (HIV) infection. HIV+ patients now survive long enough to manifest long-term symptoms and associated diseases only recently recognized as consequences of infection. Along these lines, recent studies document a significant association between HIV infection and osteoporosis. This article reviews clinical data, considers possible causal factors and presents an opinion on the clinical implications of HIV-associated metabolic bone disease. Recent findings: Clinical studies demonstrate that HIV infection is associated with reduced bone mineral density. Various factors contribute to this phenomenon. The infection itself clearly reduces bone mineral quality both directly and indirectly. Furthermore, the medications used to treat HIV show a spectrum of effects on bone. As opposed to classic osteoporosis, HIV-associated bone mineral density reduction appears to have a more pronounced effect in males. Interestingly, the protective effect of female sex appears to be entirely reversed at menopause. There remain few data regarding the incidence of fragility fractures among HIV+ patients. Summary: HIV infection is associated with reduced bone mineral density, the cause of which is likely multifactorial. Clinically, HIV must be recognized as an independent risk factor of osteoporosis and osteopenia.

Bone Quality in Perinatally HIV-Infected Children: Role of Age, Sex, Growth, HIV Infection, and Antiretroviral Therapy

Appropriate supportive care and identification of long-term sequels of therapy are of paramount importance in HIV-infected pediatric patients. As low bone mineral quality (BMQ) in patients can be considered a marker of possible degeneration in osteopenia and osteoporosis in adulthood, we evaluated bone features in a pediatric population. Forty-four patients (23 females, 21 males; aged 3-17 years) were compared with a control population (1227 healthy children: 568 females, 641 males; aged 3-18 years). Seven patients were CDC stage C, 18 B, and 18 A. All patients were vertically infected; four were naive to any antiretroviral treatment, seven were taking two NRTIs, and 32 were on HAART. BMQ was assessed by a quantitative ultrasound (QUS) technique. It measures the amplitude-dependent speed of sound (AD-SoS, m/sec) and the bone transmission time (BTT, microsec). QUS values were significantly lower in cases than in controls, even after adjustment for age and body size (AD-SoS: 1924.7 +/- 64.9 and BTT: 0.97 +/- 0.3 in controls; AD-SoS: 1879.7 +/- 57.2 and BTT: 0.80 +/- 0.32 in cases; p < or = 0.001). The associations of AD-SoS and BTT with gender, type of therapy, and CDC stages were not significant. AD-SoS and BTT were significantly associated with age (r = 0.59, p < 0.0001), skeletal age SDS (r = 0.46, p = 0.002), height (r = 0.66, p < 0.0001), and therapy duration (r = 0.31, p = 0.04). Both AD-SoS and BTT values in patients fell below mean values of controls. Follow-up of bone mineral density is important in patients to prevent long-term problems of skeletal status.

Bone Fragility and Collagen Cross-Links

Infrared imaging analysis of iliac crest biopsy specimens from patients with osteoporotic and multiple spontaneous fractures shows significant differences in the spatial variation of the nonreducible:reducible collagen cross-links at bone-forming trabecular surfaces compared with normal bone. Although the role of BMC and bone mineral quality in determining fracture risk has been extensively studied, considerably less attention has been paid to the quality of collagen in fragile bone. In this study, the technique of Fourier transform infrared imaging (FTIRI) was used to determine the ratio of nonreducible:reducible cross-links, in 2- to 4-microm-thick sections, from human iliac crest biopsy specimens (N = 27) at bone-forming trabecular surfaces. The biopsy specimens were obtained from patients that had been diagnosed as high- or low-turnover osteoporosis, as well as premenopausal women <40 years of age, with normal BMD and biochemistry, who suffered multiple spontaneous fractures. The obtained values were compared with previously published analyses of trabecular bone from normal non-osteoporotic subjects (N = 14, 6 males and 8 females; age range, 51-70 years). Collagen cross-links distribution within the first 50 microm at forming trabecular surfaces in patients with fragile bone was markedly different compared with normal bone.

Distal humerus fractures in elderly patients: results after open reduction and internal fixation

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. To analyze fracture patterns, surgical approach, complications, and functional results after open reduction and internal fixation in patients of age 60 years and older. Retrospective clinical study of two university level 1 trauma centers, including 45 patients (median age 73 years; range, 61-92 years) with surgically treated distal humerus fractures. Fracture patterns were recorded according to their AO classification. All patients were treated by open reduction and internal fixation. A clinical and radiological follow-up was obtained after a minimum of 24 months following surgery (median 87 months; range, 24-121 months). Functional results were evaluated according to the Mayo Elbow Score. Fractures with complete joint involvement were seen most often. Taking the fracture type into consideration, functional results deteriorated with degree of joint involvement. Postoperative complication rate was high, predominantly seen as screw loosening and/or implant failure at the lateral column. Neverthless, functional results were preponderating good or excellent. Factors negatively influencing outcome were joint immobilization longer than 14 days and severe joint involvement. In elderly patients, distal humerus fractures, which are often considered "osteoporotic fractures," still remain one of the most demanding challenges in trauma surgery. The present study demonstrates that despite diminished bone quality and a high complication rate, open reduction and internal fixation in elderly patients is justified. 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.

The LCP-concept in the operative treatment of distal humerus fractures – biological, biomechanical and surgical aspects

Distal humerus fractures in adults are treated by open reduction and internal fixation, which produces good results in the majority of patients. However, in elderly patients or in cases with metaphyseal comminution, stable fracture fixation still remains problematic. Anatomical joint reconstruction and primary stable osteosynthesis are often particularly difficult to achieve in this group of patients since poor bone mineral quality is frequently encountered. Consequently, longer immobilization is necessary, which is known to negatively influence functional outcome. Over the past few years, double-plate osteosynthesis techniques using different configurations have become the treatment of choice. Nevertheless, complications due to inappropriate primary stability and/or implant failure have been described. Investigations on whether the recently introduced Locking Compression Plates (LCPs) could enhance primary stability are rare. On the basis of clinical and biomechanical experiences, the authors consider LCPs a helpful tool for increasing primary stability in osteosynthesis of distal humerus fractures. LCPs might be of substantial advantage in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.