Does osteoporosis increase complication risk in surgical fracture treatment? A protocol combining new endpoints for two prospective multicentre open cohort studies.
BACKGROUND
With an ever-increasing elderly population, orthopaedic surgeons are faced with treating a high number of fragility fractures. Biomechanical tests have demonstrated the potential role of osteoporosis in the increased risk of fracture fixation complications, yet this has not been sufficiently proven in clinical practice. Based on this knowledge, two clinical studies were designed to investigate the influence of local bone quality on the occurrence of complications in elderly patients with distal radius and proximal humerus fractures treated by open reduction and internal fixation.


METHODS
The studies were planned using a prospective multicentre open cohort design and included patients between 50 and 90 years of age. Distal radius and proximal humerus fractures were treated with locking compression 2.4 mm and proximal humerus internal locking plates, respectively. Follow-up examinations were planned for 6 weeks, 3 and 12 months as well as a telephone interview at 6 months. The primary outcome focuses on the occurrence of at least one local bone quality related complication. Local bone quality is determined by measuring bone mineral density and bone mineral content at the contralateral radius. Primary complications are categorised according to predefined factors directly related to the bone/fracture or the implant/surgical technique. Secondary outcomes include the documentation of soft tissue/wound or general/systemic complications, clinical assessment of range of motion, and patient-rated evaluations of upper limb function and quality of life using both objective and subjective measures.


CONCLUSIONS
The prospective multicentre open cohort studies will determine the value of local bone quality as measured by bone mineral density and content, and compare the quality of local bone of patients who experience a complication (cases) following surgery with that of patients who do not (controls). These measurements are novel and objective alternatives to what is currently used.


BACKGROUND
Clinical Trials.gov NCT01144208 and NCT01143675.
AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600 Duebendorf, Switzerland. sabine.goldhahn@aofoundation.org
Sabine
S
Goldhahn
Franz
F
Kralinger
Daniel
D
Rikli
Marta
M
Marent
Jörg
J
Goldhahn
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D015519:Bone Density; D015331:Cohort Studies; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D007407:Interviews as Topic; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011788:Quality of Life; D011885:Radius Fractures / Q000601:surgery*; D012307:Risk Factors