Osteoporosis is a systemic skeletal disease, frequently associated with elderly persons, that manifests with a decrease of the bone mass, abnormal microarchitecture of the bones and results in increased risk of fracture occurrence. In the practice of an orthopaedic and a trauma surgeon, the most important factors that are common for senile and post-menopausal osteoporosis, include: decreased mineral density of the bones (especially the spongy bones), advanced biological age of the patient, frequent presence of coexisting diseases of the circulatory system, the respiratory system and the nervous system, hormonal abnormalities, decreased general efficiency and fitness. The so-called osteoporotic fractures include: compression fractures of the thoracic and lumbar vertebrae, distal radial fractures, as well as proximal femoral and humeral fractures (1). Applied over the years, the conservative therapy is gradually being replaced by surgery. Conservative and functional treatment remains the gold standard in treatment of fractures of the spine and the upper limb, and surgical treatment of the femoral fractures (2). However, in justified cases, all listed damages of the motoric system may be treated with surgical methods. Modern surgical techniques facilitate early return to movement, which allows managing patients without immobilization of the operated region in plaster casts, which are especially troublesome for elderly people.

Within the proximal femur, we distinguish femoral neck fractures and trochanteric fractures. In accordance with the recommendations of the Polish Society of Orthopaedics and Traumatology, which were binding over the years, femoral neck fractures were treated according to the rule that each patient has the right to spare his/her own hip joint, i.e. the objective was to perform surgical fixation and obtaining union within the area of the femoral neck. Such management required from the patient not to bear weight on the operated limb over a few weeks (or rather a few months, i.e. from 3 to 6 months), i.e. moving with assistance of elbow crutches or a walking frame. In practice, the total elimination of weight bearing by the operated lower limb in elderly and senile patients is possible only as a result of a ban of rising to a standing position. Such management favours development of such complications as: bedsores, urinary tract infections, respiratory tract infections, further worsening in efficiency and fitness, acceleration in lowering mineral density of the bones. It is also worth emphasizing that in a vast majority of cases, a specific blood supply to the femur within the area of its neck results in failure in an attempt to obtain bone union or it may lead to aseptic necrosis of the femoral head. Bipolar hip hemiarthroplasty seems to be a beneficial solution in femoral neck fractures in elderly patients. Significant advantages of this therapeutic method include: possibility of weight bearing by the operated limb from the first day after surgery, no necessity to surgically prepare the acetabulum, which shortens duration of the surgical procedure and lowers blood loss and a lower risk of joint dislocation comparing to total hip arthroplasty. Additionally the bipolar alloplasty shows no tendency of painful protrusion of the endoprosthesis head into the acetabulum, which is characteristic for the Austin-Moore hemiprosthesis (3) (fig. 1).

In principle, trochanteric fractures of the femur have been surgically treated for years. However, for a decade, an osteosynthesis method has been available, that may be recognized as the optimum method. It is the intramedullar fixation by the Gamma nail. It is charecterised by:

– an exceptionally high stability of the fixation, which allows rising to a standing position and weight bearing of operated limb before the bone union occurs,

– minimal invasiveness of the procedure – 3 skin cuts measuring approximately 4, 2 and 1 cm in length for performing closed reposition and fixation of the bone fragments,

– minimal intraoperative blood loss.