BIOMECHANICS OF LOCKING PLATE FIXATION IN OSTEOPOROTIC FRACTURES: A PROSPECTIVE CLINICAL STUDY

Abstract

Background: Osteoporotic fractures are increasingly prevalent in the aging population and present significant challenges in orthopedic management due to reduced bone mineral density, poor screw purchase, and a higher risk of fixation failure. Conventional plating techniques often fail to provide adequate stability in osteoporotic bone. Locking plate systems, functioning as fixed-angle constructs, have emerged as a biomechanically superior alternative by providing angular stability and improved load distribution independent of bone quality. Aim: To evaluate the biomechanical effectiveness, clinical outcomes, and factors influencing the success of locking plate fixation in osteoporotic fractures. Materials and Methods: This prospective observational study was conducted at a tertiary care centre in Dindigul and included 135 patients aged ≥50 years with confirmed osteoporosis (DEXA T-score ≤ -2.5) who underwent locking plate fixation for long bone fractures over a 24-month period. Demographic data, fracture characteristics, bone mineral density, and implant-related parameters were recorded. Patients were followed up for 12 months with periodic clinical and radiological evaluation. Primary outcomes included fracture union and implant stability, while secondary outcomes included functional scores (DASH/LEFS) and complication rates. Statistical analysis was performed using SPSS version 25. Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies and percentages. Chi-square test, independent t-test, and multivariate logistic regression analysis were used to identify predictors of fixation failure, with p < 0.05 considered statistically significant. Results: The mean age was 68.2 ± 7.5 years, with female predominance (64.4%). Radiological union was achieved in 91.1% of cases, with a mean union time of 16.4 ± 3.2 weeks. Complications occurred in 14.8% of patients. Functional outcomes were good to excellent in 74.1% of cases. Severe osteoporosis, suboptimal screw density, and fracture comminution were identified as independent predictors of fixation failure (p < 0.05). Conclusion: Locking plate fixation provides biomechanically stable and clinically effective management of osteoporotic fractures. Optimal surgical technique and implant configuration are essential to achieve favorable outcomes and minimize complications.