With the progress of society and the improvement of health care, the average human life expectancy has increased substantially. The aging of the population has led to a significant increase in the incidence of bone and joint injuries in the elderly, especially the incidence of osteoporotic fractures in the elderly increases significantly with age. It has been reported that the risk of fracture increases by a factor of 1 for every 5 years of age in older adults over 65 years of age. Fracture is the most serious complication of osteoporosis, and osteoporotic fractures can cause serious harm, great pain, slow healing time, and a tendency to delayed healing or non-healing. If the patient’s fracture does not heal, the time for fixation of the fracture site will be prolonged, and the local osteoporosis can be aggravated by disuse factors, forming a vicious circle, so the disability rate caused by osteoporotic fracture is high. Long-term bed rest after a fracture increases the risk of circulatory, respiratory and urinary complications in the elderly, resulting in a high mortality rate. Chen Yunzhen, Department of Orthopaedic Surgery, Qilu Hospital, Shandong University What is osteoporotic fracture? Osteoporotic fracture is a fracture that can occur under a slight external force due to a decrease in bone mass throughout the body, changes in the microstructure of bone tissue, and an increase in bone fragility. The decrease of organic components and the increase of inorganic components in the bones of the elderly make the bone less elastic and less resistant to external forces; the muscle atrophy of the elderly reduces the protective effect on the bones; the endocrine disorders and nutritional disorders of the elderly; the decrease of exercise or various chronic diseases can reduce the bone mass and cause osteoporosis. Due to osteoporosis and degenerative joint changes, fractures can be caused without obvious external forces or with minor external forces and self-stress. Etiology of osteoporotic fractures. The internal cause, which is osteoporosis. A decrease in the organic content of bone, structural changes in bone, brittle bone, and a decrease in bone strength, i.e., a decrease in the ability of bone to withstand and resist external forces, are the internal causes of fractures. External causes, often caused by minor external forces, and some patients have triggers such as slipping on flat surfaces. These include: life injuries, which occur during daily activities (including household chores), such as falls; traffic injuries, which are caused by the impact of various vehicles or overturned vehicles; and sports injuries, which occur when engaging in sports. Most due to the lack of necessary difficult to prepare for the activities before the sport, excessive fatigue and loss of control. And so on. Trauma mechanism of osteoporotic fracture. Including direct injuries: injuries caused by external forces acting directly on a part of the body. Femoral neck fracture caused by falling and landing on the hip in the elderly; fracture caused by external force striking a part directly, all belong to this scope; indirect injury: injury caused by external force through conduction, lever or rotation to a distant part of the force. For example, a fracture of the distal end of the flexor or the surgical neck of the rib that occurs when the palm of the hand supports the ground during a slip and fall; a compression fracture of the thoracolumbar spine caused by a violent bump in a vehicle. The chance of indirect injury is also more common in the elderly; muscle pull: sudden and violent muscle contraction can pull off the bone at the muscle attachment. For example, when falling, the quadriceps muscle contracts violently, causing patella fracture; accumulated strain: long-term, repeated, minor direct or indirect injuries can be concentrated in a point of the bone fracture, common fatigue fractures are 2, 3 metatarsal fractures, fractures are generally less displaced, but slow healing; bone disease: osteoporotic bones combined with other pathologies, fractures can occur when subjected to a slight external force, called pathological fractures. Some scholars also regard osteoporotic fractures as pathological fractures. Diagnosis of osteoporotic fracture. History: Note that osteoporotic fractures are often caused by minor external forces and can have a history of trauma or no clear history of trauma. Some patients have a history of slipping on a flat surface or taking a bumpy ride in a car, so the diagnosis is easy to clarify. In some patients, the fracture is even caused by kicking the quilt with the foot while sleeping. Some patients may also show an insidious process, directly manifesting as pain at the site of the fracture, which is obvious at night and early morning and decreases during the day, and worsens when bending or muscle movement or coughing. Examination: Note the site of the osteoporotic fracture. The bony ends of long bones and vertebrae are the best sites. Among them, the incidence of Koch fracture of the lower end of flexure is the highest, followed by hip fracture, vertebral fracture, and proximal rib fracture in that order. x-ray examination: remains the most important diagnostic measure. x-ray films show signs of osteoporosis, such as reduction of bone trabeculae and thinning of bone cortex. The fracture mainly shows the characteristics of fragility fracture. Comminuted fractures often occur in the extremity bone ends with minor violence, compression fractures in one or more segments of the vertebral body, the thoracic vertebrae may show a wedge-shaped change, the lumbar vertebrae are biconcave, etc. Principles of treatment for osteoporotic fractures : The treatment plan is determined according to the fractures at different sites, the degree of osteoporosis of the patient, the patient’s age and gender status, basic physical fitness, and tolerance to surgery. Spinal osteoporotic compression fractures: most of the spinal compression fractures caused by osteoporosis occur in the thoracolumbar spine. The medical history may include a history of minor violent trauma, or a history of no obvious trauma and a visit for low back pain. Generally, there is no serious dislocation or combined spinal cord injury, and it is a simple vertebral wedge fracture. The patient can lie flat on a hard bed, pay attention to a soft pillow at the fracture, early functional exercise of the lumbar back muscles can be performed after half a month, and bedside activities can be performed after 6-8 weeks; percutaneous vertebroplasty can also be performed to reduce the patient’s pain, improve the quality of life, and effectively reduce various complications of long-term bed rest. For osteoporotic spinal compression fractures combined with spinal cord injury or fracture fragment displacement may involve spinal nerve injury, surgical treatment, such as anterior, lateral anterior, posterior decompression exploration and internal fixation with bone graft fusion, is recommended. Osteoporotic fractures of the femoral neck: most of them are life-threatening injuries, such as slipping or falling on a flat surface, falling from a bed or a chair, etc. Typical clinical signs of fracture: pain in the affected hip after the injury, inability to walk or stand. The affected limb is deformed by internal and external rotation and shortening, and the pressure pain and axial percussion pain in front of the hip are obvious. What should be alerted is that those inlay fractures without dislocation often have mild symptoms, no deformity of the affected limb, only some pain in the groin or knee, and can generally still walk, which can easily be mistaken for soft tissue injury and missed. A closer examination may reveal a reduced range of motion of the medullary joint, and defensive muscle spasm often occurs during passive activities. Therefore, for elderly people who complain of hip pain and limited movement after injury, the possibility of femoral neck fracture should be considered and should be confirmed by radiographs. If the fracture is not shown at that time, but there is still clinical suspicion, the patient can be allowed to rest in bed, and then X-ray review after two weeks, if there is indeed a fracture, the fracture line is clearly visible at this time due to the local absorption of the fracture. Femoral neck fractures are often complicated and difficult to treat because of secondary fracture non-union and ischemic necrosis of the bone as well as concomitant cardiovascular lesions. The main treatment methods are: (1) for abducted femoral neck fractures and fatigue fractures without obvious displacement, surgery is generally not necessary and traction therapy can be used. Such as with skin traction for 3-4 weeks, and then go to traction affected limb without weight-bearing crutches to move on the ground. Avoid doing abduction and external rotation movement until the fracture heals. (2) Manipulative repositioning, splinting and external fixation treatment with Chinese herbal medicine. (3) External fixator therapy Cao Jianzhong and others introduced the “multifunctional external fixator for lower limbs” to treat femoral neck and intertrochanteric fractures with good results. The treatment is characterized by elastic fixation and gravitational traction, using the principle of reaction force to act on the fracture site to achieve and maintain reset. (4) Surgical treatment For patients with unsuccessful closed fracture reduction, surgical incision and internal fixation should be performed as early as possible. This is especially indicated for displaced femoral neck fractures in elderly patients under 65 years of age. For elderly patients with femoral neck fractures whose general condition can still tolerate the effects of a larger surgery, incisional hip replacement can be considered. Artificial femoral head replacement can be applied to fresh femoral neck, subtrochanteric and comminuted fractures with displacement, old fractures that do not heal, or ischemic necrosis of the femoral head without osteoarthritis, if the patient is older than 65-75 years old. Osteoporotic fracture of the femoral trochanter: The diagnostic points for fracture of the trochanter are basically the same as those for fracture of the femoral neck. The local symptoms and signs are more obvious. Swelling and pressure of the hip, external rotation and shortening of the injured limb are more pronounced, and subcutaneous bruising may appear quickly, whereas this sign is not present in intracapsular fractures of the femoral neck. The systemic reaction is also more severe. Foreign literature reports a high mortality rate of about l0%-20% for fractures of the oldest ramus. Therefore, when the patient is of high age and has obvious signs of hip fracture and obvious systemic symptoms with minor violence, the likelihood of fracture of the trochanter is higher. Although the incidence of trochanteric fractures is similar to that of femoral neck fractures, the age of predilection is not the same. The latter is most often seen around the age of 60 years. The average age of the former is about 5-6 years higher, and the incidence is much lower in young and middle-aged adults and children and adolescents in coarctation fractures. Since intertrochanteric fractures often occur in elderly people, the general condition of elderly patients is poor, and long-term bed rest after fracture is very likely to cause systemic complications, so the most important problem for the treatment of patients with intertrochanteric fractures is how to get out of bed early and prevent systemic complications, and at the same time to solve the skeletal inversion deformity. The specific treatment should be based on the patient’s age, general condition, fracture type and fracture displacement, and broken inversion deformity. (1) Traction therapy There are two types of traction: skin traction and bone traction. Skin traction is suitable for non-displaced fractures. Generally, 6-8 weeks of traction is a course of treatment. Bone traction is used for all types of intertrochanteric fractures. Generally, tibial tuberosity direct sliding traction is used, and the traction weight is about lokg. When doing bone traction, care should be taken to place the affected limb in a mild external booth, mild external rotation or rotational neutral position. The duration of bone traction is usually 8-12 weeks. Weight-bearing of the affected limb must be done after 12 weeks of traction. (2) Surgical treatment For elderly patients with intertrochanteric fracture who are older, in poor general condition, with unstable fracture and unable to tolerate long-term bed traction, if there are no obvious contraindications to surgery, surgical treatment is beneficial for patients to leave bed early, reduce complications, decrease mortality and correct and prevent inversion deformity. The following methods are often used: internal fixation of the nail plate, internal fixation of the Ender nail, internal fixation of the V-shaped intramedullary pin, etc. Artificial hip or femoral head replacement can also be considered according to the situation. Osteoporotic fracture of the distal radius: the main points of diagnosis are a history of falling with the palm of the hand in the dorsal wrist extension position; meal fork-like deformity and shotgun-like deformity of the wrist; in addition to the fracture line visible on x-ray, the normal palmar and ulnar inclination angles disappear or become angular in the opposite direction. Conservative treatment is mostly applied to fractures that are stable, without obvious displacement and deformity changes, and without combined joint dislocation. It is usually protected by external fixation with a plaster brace or splint for 3-4 weeks, and early functional exercise of the hand is noted. For patients with displaced fractures, closed reduction should be performed under local anesthesia and external plaster fixation should be performed in the repositioned state, and internal fixation with Kirschner pins after closed reduction can also be considered. For severely unstable fractures, comminuted fractures, fractures with potential for malunion, fractures with severe displacement affecting normal function, and those with severe dislocation of the wrist joint, they should be treated surgically with incisional reduction and internal fixation with Kirschner pins or plate screws. Depending on the situation, flexor osteotomy or total or subtotal ulnar head osteotomy can also be considered. For distal flexor fractures, most scholars prefer closed repositioning treatment and ignore surgical treatment. However, it has been confirmed through follow-up surveys that extremely complicated cases of distal flexor fractures may have serious complications if they are not treated with early surgical reduction and internal fixation. Therefore, the treatment of distal flexor fractures should be determined on a case-by-case basis. Other places, such as ribs, femur, and pelvis, also often have fragility fractures, where fractures occur with minor external force or severe comminuted fractures with mild violence, all suggesting the presence of osteoporosis, but the severity of the fracture does not represent the degree of bone loss. Prevention of osteoporotic fractures. Osteoporosis brings great inconvenience and pain to patients’ lives, and the treatment is very slow, and fractures can be life-threatening; therefore, special emphasis should be placed on the implementation of tertiary prevention. Primary prevention: It should start with children and adolescents, such as paying attention to reasonable dietary nutrition, consuming more foods with high Ca and P, insisting on physical exercise and receiving more sunbathing, and increasing the peak bone mass to the maximum is the best measure to prevent osteoporosis later in life; Secondary prevention: When people reach middle age, especially women after menopause, bone loss is accelerated. Bone density examination should be conducted annually during this period, and if rapid bone mass is found, early preventive and curative measures should be taken; tertiary prevention: patients with degenerative osteoporosis should be actively treated with drugs to inhibit bone resorption and promote bone formation. At present, the main drugs for the treatment of osteoporosis are the following five kinds: 1, estrogen supplementation therapy: estrogen can prevent and treat female osteoporosis; 2, alendronate: inhibit osteoclasts, while having the effect of prevention and treatment of osteoporosis; 3, calcium and vitamin D: can be used in combination, the effect is better; 4, bone peptide preparations, is a new clinical drugs used to treat rheumatoid rheumatoid The results of the multicenter, double-blind, randomized PROOF study suggest that the use of salmon calcitonin for osteoporotic fractures may reduce the risk of recurrent vertebral fractures by 36% and the risk of multiple fractures by 45%, although the increase in BMD is not significant. study, with mild to moderate increases in BMD. It is generally believed that calcitonin inhibits osteoclast activity directly through the CT receptor (CTR) of the osteoclast membrane and inhibits the maturation of osteoclasts, thus inhibiting bone resorption; we believe that this is related to an improvement in the content of organic matter in the bone tissue and its arrangement structure, resulting in an increase in bone toughness. In the experiment, after supplementation with salmon calcitonin in osteoporotic rats, the collagen content increased, the organic matter content of bone tissue increased, the bone biomechanical parameters were enhanced compared with the control group, and the bone density also increased. This indicates that the treatment of osteoporosis patients with salmon calcitonin can reduce bone resorption, increase bone formation, especially increase bone organic matter (type I collagen), and increase bone mass and bone quality. This further confirms that the incidence of osteoporotic fractures is significantly reduced after salmon calcitonin application, despite the limited increase in BMD. In conclusion, osteoporotic fracture is a major hazard, which not only greatly increases the economic burden of patients and society, but also endangers patients’ lives. However, osteoporosis can be prevented, and strengthening the awareness of self-care, early detection and treatment of osteoporosis, and active scientific intervention will be of great significance to improve the quality of life of middle-aged and elderly people in China.