Purpose of review: Osteoporosis compromises the structural strength of bone, making fracture fixation a surgical challenge. Special strategies and newly designed locking plate fixation enhance the surgeon's ability to treat these fractures. This essay reviews these developments.
Recent findings: Conventional plate and screw fixation achieves stability by creation of a friction force between the plate and bone. Osteoporotic bone, especially in metaphyseal areas, is too weak to allow sufficient screw torque to be generated for development of stability in plated fractures. Modified techniques that achieve load sharing improve the results of fracture repair in these cases. Locking plate fixation, which creates a single beam construct not relying on the generation of a friction force, is a significant advantage in osteoporotic fracture care. Early experience with the use of locking plates designed for various specific fractures suggests that this new technology results in enhanced fixation and better clinical outcomes.
Summary: Surgeons must apply specific techniques that incorporate load sharing when surgically managing osteoporotic fractures. Locking plates will offer a significant advantage compared with conventional plates when treating fractures in osteoporotic bone.