The increasing rate of fragility fractures in the developed world is now well- documented and presents a significant challenge to Orthopaedics. Although guidelines exist for the management of osteoporosis, both before and after fracture events, little work has yet been done to measure the effect of interventions on reducing the rate of second fractures in the at-risk population. The longitudinal study, begun at The Canberra Hospital, aims to compare rates of second fractures in two populations of patients over 40 years who have sustained a low-impact, minor trauma fracture. A retrospective study of medical records provides baseline information on current intervention rates for osteoporosis. Secondly, a prospective study population is recruited from patients presenting to Fracture Clinic at The Canberra Hospital. Patients presenting to clinic will, after consent, undergo a screening process including blood test and DEXA scans, to confirm or reject a diagnosis of osteoporosis. Those diagnosed will be referred for medical management as well as non-pharmacological interventions. Follow-up will be conducted at 12 months with repeat testing for bone density to determine whether the interventions have produced measurable improvement and patients will be followed up for five years to establish the rate of re-fracture. A progress report will be presented to the conference advising on findings from the retrospective arm, scheduled for completion in September 2009, and results to date of the prospective arm. The study is a current work-in-progress, and will provide a basis for future research in this area.
Traditional fixation with a DHS or Gamma Nail has seen instances of excessive fracture collapse, screw cut out, re-operation, and loss of independence for the patient. The Gotfried PerCutaneous Compression Plate (PCCP) is a novel solution reducing the morbidity of fixing intertrochanteric fractures. Claimed advantages include relative preservation of the lateral femoral cortex, achieving better fracture stability, less collapse, and a percutaneous technique. This is a pilot study of the introduction of the PCCP. At the time of abstract submission, 42 cases have been undertaken in Ballarat. The study assesses the safety and learning curve issues. Outcomes include length of stay, morbidity, and return to independence. A comparison to a historical cohort is made. Of the first 42 cases, no operative complications occurred. The operations were no longer than traditional fixation methods, and no “learning curve” errors occurred. One patient with severe osteoarthritis of the hip preoperatively still required a hip replacement, which was performed 3 months later without difficulty. Two patients died within a week post-operatively. The PCCP provided an eloquent low morbidity solution to even extremely displaced fractures, allowing comfortable nursing and a high proportion of patients maintained their previous level of independence. The PCCP is a better way of fixing intertrochanteric fractures. It prevents excessive collapse, maintains femoral shaft offset, has less surgical morbidity, and consequently has minimized the loss of independence often seen with the fractures.
