Augmentation of internal fixation of osteoporotic ankle fracture using injectable bone substitute

Bone failure, not implant breakage, is the primary mode of failure of internal fixation in an osteoporotic bone. Because bone mineral density correlates with the holding power of screws, osteoporotic bone often lacks the strength to hold plates and screws securely. Resistance to pull out of a screw placed in bone depends on the length of the screw purchase, the thread of the screw, and the quality of the bone itself. Therefore, long tibia-pro-fibula screws that extend from the fibula into the tibial metaphysis can obtain additional purchase and have better resistance against failure by pull out.A variety of substances have also been used to enhance screw purchase in bone, including bone autograft or allograft, bone cement, or bone substitutes such as calcium sulfate and calcium phosphate. There are no reports of use of these substances to enhance screw purchase in internal fixation of an osteoporotic ankle fracture.The purpose of this article is to report a novel technique of internal fixation of an osteoporotic ankle fracture using a combination of injectable bone substitute and long tibia-pro-fibula screws.