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EVAN, MD

ORTHOPAEDIC AND TRAUMATOLOGY


UNIVERSITY OF KRISTEN KRIDA WACANA
INTRODUCTION
DEFINITION
Skeletal sistemic disorder characterized by low bone
mass and by a microarchitectural deterioration of
bone with increased insidence of fragility fracture
Intoduction
SECONDARY OSTEOPOROSIS
Diagnostic
1. BMD DXA (Dual X-ray Absorptiometry)
2. FRAX ( Fracture Risk Assesment Tools )
DIAGNOSTIC
FRAX
ORTHOPAEDIC TREATMENT
SPINE
Most fragility
2nd mortality and morbidity in elderly group
History of fragility fracture risk re-fracture 4 times
Asian and white women
Lumbar>>
TREATMENT
The most frequent treatment is conservative.
bed rest and walking with a corset
Indication of surgery fracture pattern and stability
Surgical options :
a. Minimal Invasive : vetebroplasty , kyphoplasty
b. Vetebral fusion and stabilization with bars and
screw
Vertebroplasty
Vertebroplasty: Percutaneous injection of a bone-filler,
typically polymethylmethacrylate, directly into a
fractured vertebral body with use of fluoroscopic
guidance.
Goals :
a. Pain relief
b. Prevention of further vertebrae
Inability to correct vertebrae height, not correction of
kyphotic deformity, extravertebral extravatation
Kyphoplasty
Kyphoplasty: Percutaneous insertion of an inflatable
bone tamp into a fractured vertebral body with use of
fluoroscopic guidance.
Embolic increase of intravertebral pressure while
ballooning.
KYPHOPLASTY
PEDICLE SCREW AND BARS
HIP FRACTURE
Problem
1. Cost of treatment hip fracture is huge.
2. Complications of hip fracture DVT, bedsores,
pneumonia and death.

Treatment is surgery
Femoral Neck Fracture
Consider :
a. Fracture type
b. Patient physiologic age
c. Presence of symptomatic arthritis
Nondisplaced and valgus impacted canullated
screw fixation
Displaced closed reduction and percutaneus
pinning, sliding hip screw, Hemiarthropalsty, Total
Hip Arthroplasty.
Canullated Screw

Hemiarthroplasty (HA)
Total Hip Arthroplasty
Intertrochanteric / Subtrochanteric
Fracture
1. Stable Intertrochanteric fracture Sliding Hip screw
device or intramedullary nailing.

2. Unstable intertrochanteric fracture intramedullary


nailing
Intramedullary Nailing Sliding Hip Screw (DHS )
Distal Radius Fracture
Treatment Principles There are three main pillars with
regard to the treatment of distal radial fracture in the
osteoporotic patient:
(1) Primary prevention
(2) Acute management
(3) Reduction in future fracture risk
PRIMARY PREVENTION
The United States Preventive Services Task Force
(USPSTF)
1. Female sixty-five years or older
2. Fracture risk
3. Greater than that of a sixty five-year-old white
woman with no additional risk factors DXA
Pharmacological : bifosphonates, esterogen,
calcitonin, selective esterogen modulator.
Acute Management
Traditionally closed reduction and/or casting,
malunion in more than half of cases.
Operative treatment
advantages
1. Improved grip strength
2. Improved radiographic outcomes with regard to
dorsal tilt, radial inclination, and radial length
REDUCTION IN FUTURE RISK
Distal radial fracture can be associated with an
important functional loss

50% worsening ability to prepare meals, perform


heavy housekeeping, climb ten stairs, go shopping ,
and get out of a car.

Calcium and vitamin-D supplementation, exercise, fall


prevention and communication with primary care
provider.
Distal Radius Fracture
Distal Radius Fracture
PREVENTION OSTEOPOROTIC
FRACTURE
All women 65 years old BMD & FRAX
Identified secondary osteoporotic
Pharmacological : Adequate calcium and vitamin D
intake
Non pharmacological :
- Reduce risk of falls
- exercises
- lowering bed height
- External hip protector
Pharmacological
External Hip Protector
CONCLUSSION
BMD and FRAX osteoporotic and risk of
osteoporotic fracture.
Spine, Hip and Distal radius fracture most common
osteoporotic fracture.
Spine fracture stable conservative
Hip and Distal Radius fracture operative
Prevention of osteoporotic fracture
a. Non-pharmacological
b. Pharmacological