The impact of osteoporosis on the classification of hip and wrist fractures.
The impact of osteoporosis on the classification of hip and wrist fractures.
复制标题
骨质疏松症对髋部和腕部骨折分类的影响。
DOI：
10.1016/j.ics.2005.06.084
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
C. Heiss
中科院分区：
文献类型：
--
作者：
L. Hoesel;M. Pausch;R. Schnettler;C. Heiss
背景
先前的研究表明骨密度、骨折固定的稳定性和结果之间存在相关性。由于目前的骨折分类没有考虑骨质疏松症，因此对髋关节和腕关节骨折患者进行了前瞻性放射学分析，以评估骨质疏松症对骨折分类的影响。
材料/方法
总之，77例髋关节或腕关节骨折的连续患者在骨折持续24小时内前瞻性招募。根据性别、骨折部位、骨折类型和骨密度（BMD）将患者分为亚组。使用广泛接受的髋关节和腕关节骨折分类系统，评估骨质疏松症对骨折分类的影响。
结果
两种骨折类型均以骨质疏松为主，骨密度与年龄呈显著负相关。股骨转子间骨折更常见，在严重程度等级之间分布均匀，而不太常见的股骨颈骨折主要是不稳定骨折。绝经后患者持续更严重的关节内粉碎性腕关节骨折，这是没有发现使用费尔南德斯分类。
结论
股骨粗隆间骨折的发生率高于股骨颈骨折，但严重程度较低，这与腕部骨折分类之间的不一致性相矛盾，可能表明骨质疏松症中骨折分类不完整。鉴于骨质疏松性骨折的高发生率，将骨矿物质状态纳入骨折分类系统可能会改善术前评估、植入物稳定性和结局。
BACKGROUND
Previous studies demonstrated a correlation between bone density, stability of fracture fixation, and outcome. Because current fracture classifications do not take osteoporosis into account, a prospective radiological analysis was conducted of patients with hip and wrist fracture to evaluate the impact of osteoporosis on fracture classification.
MATERIAL/METHODS
Altogether, 77 consecutive patients with either hip or wrist fracture were prospectively recruited within 24 hours of sustaining the fracture. The patients were assigned to subgroups according to gender, fracture site, fracture type, and bone mineral density (BMD). Using widely accepted classification systems for hip and wrist fractures, the impact of osteoporosis on fracture classification was assessed.
RESULTS
Osteoporosis dominated in both fracture types and bone mineral density showed a significant negative correlation with age. Pertrochanteric fractures were more frequent, showing an equal distribution among severity grades, while less frequent femoral neck fractures were mainly unstable fractures. Postmenopausal patients sustained more severe intraarticular comminuted wrist fractures, which were not found using the Fernandez classification.
CONCLUSIONS
The contradiction between the higher incidence but lower severity of pertrochanteric fractures compared with femoral neck fractures in osteoporotic bone and inconsistencies between the classifications of wrist fractures may indicate incomplete fracture classification in osteoporosis. Given the high incidence of osteoporotic fractures, incorporating bone mineral status into fracture classification systems may improve preoperative assessment, implant stability, and outcome.