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Challenges and Solutions in Geriatric Fracture

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Geriatric Medicine".

Deadline for manuscript submissions: 20 July 2026 | Viewed by 698

Special Issue Editors


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Guest Editor
Center for Geriatric Trauma, Department of Surgery, St. Antonius Hospital, 3543 AZ Utrecht, The Netherlands
Interests: traumageriatry; hip fracture care; advanced care planning; shared decision-making; palliatieve care; predicting models; implemantation studies
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Guest Editor
Department of Trauma Surgery, St Antonius Hospital, Utrecht, The Netherlands
Interests: geriatric medicine; geriatric trauma; epidemiology; implementation science

Special Issue Information

Dear Colleagues,

Geriatric fractures are rapidly increasing worldwide as populations age, bringing unique clinical challenges related to multimorbidity, frailty, complex decision-making, and variations in postoperative recovery. Over the past decades, growing awareness of these challenges has led to new models of multidisciplinary care and research interest in optimizing outcomes for older adults with fractures.

This Special Issue aims to highlight the current state of the field, identify persistent gaps, and share innovative strategies that improve surgical and nonsurgical management, rehabilitation, and long-term recovery in this population. We seek to bring together clinicians, scientists, policymakers, and allied health professionals dedicated to advancing geriatric fracture care.

We welcome submissions presenting cutting-edge research, including observational studies, clinical trials, and qualitative studies. Papers focusing on frailty, comorbidity management, perioperative optimization, rehabilitation, shared decision-making, and patient-centered outcomes are especially encouraged. We also invite authors to submit studies on the timing of hip fracture surgery (especially for patients on anticoagulants), resource allocation in geriatric trauma, new trends in periprosthetic fractures, and clinical pathways in geriatric trauma. Both original research and high-quality reviews will be considered. High-quality study protocols will also be considered.

Dr. Detlef Van der Velde
Dr. Henk Jan Schuijt
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • geriatric
  • fracture
  • frailty
  • hip fracture
  • comorbidity
  • perioperative optimization
  • orthogeriatrics
  • rehabilitation
  • shared decision-making
  • postoperative outcomes
  • mortality and morbidity
  • functional recovery
  • multidisciplinary care
  • quality of life
  • recovery
  • mobility
  • palliative care

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Published Papers (1 paper)

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Research

16 pages, 1147 KB  
Article
Blood Transfusion Risk Following Early Versus Delayed Surgery in Hip Fracture Patients on Direct Oral Anticoagulants: A Study Protocol for a Natural Experiment
by Tim Schiepers, Diederik Smeeing, Hugo Wijnen, Hanna Willems, Frans Jasper Wijdicks, Elvira Flikweert, Diederik Kempen, Eelke Bosma, Johannes H. Hegeman, Marielle Emmelot-Vonk, Detlef van der Velde and Henk Jan Schuijt
J. Clin. Med. 2026, 15(2), 758; https://doi.org/10.3390/jcm15020758 - 16 Jan 2026
Viewed by 507
Abstract
Background: Early surgical intervention is associated with improved outcomes in hip fracture care, yet in patients using Direct Oral Anticoagulants (DOACs), surgery is frequently delayed due to concerns about increased intraoperative bleeding. Despite the increasing prevalence of hip fracture patients on DOACs, [...] Read more.
Background: Early surgical intervention is associated with improved outcomes in hip fracture care, yet in patients using Direct Oral Anticoagulants (DOACs), surgery is frequently delayed due to concerns about increased intraoperative bleeding. Despite the increasing prevalence of hip fracture patients on DOACs, no consensus exists on optimal surgical timing. This has led to substantial practice variation between hospitals, with some operating within 24 h of last DOAC intake and others delaying surgery beyond 24 h. This study hypothesizes that early surgery within 24 h results in a non-inferior blood transfusion risk compared to delayed surgery 24 h or more after last DOAC intake in hip fracture patients on DOACs. This protocol describes the design and methodological rationale of a natural experiment. Methods and analysis: A multicenter cohort study designed as a natural experiment will be conducted across seven Dutch level 2 trauma centers, using predefined and standardized prospectively collected variables from electronic health records. Centers will adhere to distinct local surgical timing protocols, forming two cohorts: early surgery within 24 h and delayed surgery 24 h or more after last DOAC intake. Patients presenting with an isolated hip fracture who are using a DOAC and have taken their last dose within 24 h before admission will be included. The primary endpoint is postoperative blood transfusion. Secondary endpoints include additional bleeding-related outcomes, thrombotic and postoperative complications, and hospital length of stay. The primary analysis will be conducted on a per-protocol basis, with an intention-to-treat analysis performed as a supplementary assessment. Non-inferiority will be established if the upper bound of the one-sided 95% confidence interval for the risk difference does not exceed the predefined margin of 5%. Ethics and dissemination: Ethical approval was obtained from the Medical Ethics Committee United, Utrecht, The Netherlands. As this is a cohort study without altering clinical care, individual informed consent is not required. All data will be pseudonymized, and findings will be disseminated through peer-reviewed journals and scientific conferences. Registration details: Medical Ethics Committee United, Utrecht, The Netherlands, registration number W25.034. Full article
(This article belongs to the Special Issue Challenges and Solutions in Geriatric Fracture)
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