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Advances in Orthopedic Trauma Surgery in Geriatrics
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Advances in Orthopedic Trauma Surgery in Geriatrics

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

Deadline for manuscript submissions: 30 November 2024 | Viewed by 4873

Special Issue Editor

Prof. Dr. Ulrich Christoph Liener

E-Mail Website
Guest Editor
Department of Orthopedics and Trauma Surgery, Marienhospital, 70199 Stuttgart, Germany
Interests: orthopedics; geriatric trauma; fracture; hip fracture; upper extremity surgery

Special Issue Information

Dear Colleagues,

Despite recent advances in implant designs and surgical techniques, the management of geriatric fracture patients is still challenging because of their high prevalence of comorbidities and frailty. Although the standardized geriatric comanagement of trauma patients has resulted in a significant reduction in postoperative morbidity and mortality, much of our current care is still not optimal.

This Special Issue focuses on novel approaches to peri-operative care, fracture surgery, medical care, rehabilitation and secondary fracture prevention. Because the modern treatment of geriatric trauma patients is multi-professional, we invite authors from all professions involved in the treatment of geriatric patients to submit appropriate manuscripts.

Prof. Dr. Ulrich Christoph Liener
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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 fractures
  • orthogeriatric care
  • osteoporosis
  • frailty
  • fragillity fractures
  • multidisciplinary care

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Published Papers (5 papers)

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Research

11 pages, 1216 KiB  
Article
Correlation Between Reduced Daily Living Competence and the Risk of Postoperative Delirium in Orthopedics and Trauma Surgery
by Louisa Katharina Rahm, Henriette Louise Moellmann, Carla Stenmanns, Erik Schiffner, Joachim Windolf, Helmut Frohnhofen and David Latz
J. Clin. Med. 2024, 13(22), 6722; https://doi.org/10.3390/jcm13226722 - 8 Nov 2024
Viewed by 344
Abstract
Background/Objectives: Postoperative delirium is a prevalent and serious complication among elderly patients following surgical procedures. Prior research indicates that reduced competence in daily living, as evidenced by limitations in performing Activities of Daily Living (ADL), is directly associated with reduced patient mobility. This [...] Read more.
Background/Objectives: Postoperative delirium is a prevalent and serious complication among elderly patients following surgical procedures. Prior research indicates that reduced competence in daily living, as evidenced by limitations in performing Activities of Daily Living (ADL), is directly associated with reduced patient mobility. This study aimed to investigate the potential role of preoperative mobility as a risk factor for the development of postoperative delirium. Methods: To assess preoperative mobility, a comprehensive geriatric evaluation of daily living competence was conducted. This included the Katz Index of Independence in ADL, which assessed basic daily activities over the preceding 14 days, and the Instrumental Activities of Daily Living Scale (IADL). Postoperatively, delirium monitoring was performed twice daily for seven days using validated delirium screening tools, including the Nursing Delirium Screening Scale, the Confusion Assessment Method, and the 4ATest. Results: A significant correlation was observed between the incidence of delirium and the IADL scores in all patients, with p < 0.001 for men and p = 0.001 for women. Among emergency patients, the Katz Index scores significantly differed between those who developed delirium and those who did not (p = 0.015). Additionally, a significant correlation was found between the Katz Index and the incidence of delirium in both groups (p < 0.001). Conclusions: The findings of this study emphasize the necessity of preoperative geriatric assessment using tools such as the Katz Index or IADL to identify patients at risk of delirium. The results confirm the importance of enhanced postoperative monitoring for potential delirium. For elective patients, prehabilitation should be considered when reduced daily living competence is identified. For emergency patients, immediate postoperative interventions, including intensive mobilization and orthogeriatric co-management, are recommended. Full article
(This article belongs to the Special Issue Advances in Orthopedic Trauma Surgery in Geriatrics)
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10 pages, 238 KiB  
Article
Open Reduction and Internal Fixation Is a Feasible Alternative to Femoral Revision Arthroplasty in Geriatric Patients with Vancouver B2/3 Type Periprosthetic Fractures: A Study Analyzing In-Hospital Outcomes
by Christopher Lampert, Christoph Linhart, Boris Michael Holzapfel, Wolfgang Böcker, Carl Neuerburg and Yunjie Zhang
J. Clin. Med. 2024, 13(21), 6475; https://doi.org/10.3390/jcm13216475 - 29 Oct 2024
Viewed by 488
Abstract
Purpose: The surgical management of periprosthetic femoral fractures is particularly challenging in geriatric patients due to physiological limitations. The choice between open reduction and internal fixation (ORIF) and hip revision arthroplasty for treating Vancouver B2 and B3 fractures remains controversial. This study [...] Read more.
Purpose: The surgical management of periprosthetic femoral fractures is particularly challenging in geriatric patients due to physiological limitations. The choice between open reduction and internal fixation (ORIF) and hip revision arthroplasty for treating Vancouver B2 and B3 fractures remains controversial. This study aims to contribute further evidence by analyzing the in-hospital outcomes in geriatric patients with Vancouver B2/3 fractures. Methods: This retrospective study analyzed 133 patients treated for Vancouver B2/3 fractures at a level I trauma center from 2017 to 2023. Data were collected on preclinical characteristics, comorbidities, Vancouver classification, surgery-related parameters, and postoperative outcomes for an age- and gender-matched analysis. A subgroup analysis was also conducted on patients classified as American Society of Anesthesiologists (ASA) class 3 and 4. Results: Among the 133 patients, 85 suffered Vancouver B2 fractures and 48 Vancouver B3 fractures. Age-and-gender-matched analysis revealed that ORIF was more commonly performed in patients with higher ASA grades. A subgroup analysis of ASA 3 and 4 patients and an age-and-gender-matched analysis showed that ORIF resulted in shorter operation times and less blood loss. No significant differences were found in mortality or complication rates. Conclusions: ORIF is associated with shorter operation times, less bleeding, and comparable in-hospital outcomes in treating Vancouver B2/3 fractures in higher-risk geriatric patients compared to revision arthroplasty. The retrospective design and small sample size in the ORIF group are limitations of the study. Further studies with functional evaluation are still required. Full article
(This article belongs to the Special Issue Advances in Orthopedic Trauma Surgery in Geriatrics)
12 pages, 245 KiB  
Article
Intensive Multiprofessional Rehabilitation Is Superior to Standard Orthogeriatric Care in Patients with Proximal Femur Fractures—A Matched Pair Study of 9580 Patients from the Registry for Geriatric Trauma (ATR-DGU)
by Ulf Bökeler, Ulrich Liener, Hannah Schmidt, Nils Vogeley, Vanessa Ketter, Steffen Ruchholtz and Bastian Pass
J. Clin. Med. 2024, 13(21), 6343; https://doi.org/10.3390/jcm13216343 - 23 Oct 2024
Viewed by 422
Abstract
Background: Orthogeriatric treatment, which involves a collaborative approach between orthopedic surgeons and geriatricians, is generally considered to be superior to standard care following hip fractures. The aim of this study was to investigate additional effects of a geriatrician-led multidisciplinary rehabilitation program. Methods: In [...] Read more.
Background: Orthogeriatric treatment, which involves a collaborative approach between orthopedic surgeons and geriatricians, is generally considered to be superior to standard care following hip fractures. The aim of this study was to investigate additional effects of a geriatrician-led multidisciplinary rehabilitation program. Methods: In this matched paired observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery were included. Between 1 January 2016 and 31 December 2022 data were recorded from hospital admission to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a registry of older adults with hip fractures. Out of 60,254 patients, 9580 patients met the inclusion criteria, 4669 patients received early multiprofessional rehabilitation (EMR) and 4911 patients were treated by standard orthogeriatric co-management (OGC). Results: Compared to standard orthogeriatric treatment, multiprofessional therapy significantly lowered the 7-day mortality rate (2.89% vs. 5.11%) and had a significant impact on walking ability seven days after surgery (86.44% vs. 77.78%). Conclusions: In summary, a geriatrician-led multiprofessional rehabilitation program resulted in lower mortality and improved walking ability than standard orthogeriatric care. Full article
(This article belongs to the Special Issue Advances in Orthopedic Trauma Surgery in Geriatrics)
10 pages, 904 KiB  
Article
Fracture Severity and Triangular Fibrocartilage Complex Injury in Distal Radius Fractures with or without Osteoporosis
by Ho-Won Lee, Ki-Tae Kim, Sanghyeon Lee, Joon-Hyeok Yoon and Jung-Youn Kim
J. Clin. Med. 2024, 13(4), 992; https://doi.org/10.3390/jcm13040992 - 8 Feb 2024
Cited by 1 | Viewed by 1557
Abstract
The purpose of this study was to investigate the fracture morphology of distal radius fractures (DRFs) with the status of triangular fibrocartilage complex (TFCC) foveal insertion in patients with or without osteoporosis and to identify the relationship between osteoporosis and foveal tear. Seventy-five [...] Read more.
The purpose of this study was to investigate the fracture morphology of distal radius fractures (DRFs) with the status of triangular fibrocartilage complex (TFCC) foveal insertion in patients with or without osteoporosis and to identify the relationship between osteoporosis and foveal tear. Seventy-five patients who underwent surgery for DRF from January 2021 to September 2023 were included. All patients were evaluated by standard radiography and dual-energy X-ray absorptiometry and underwent a 3.0 T magnetic-resonance imaging examination of the involved wrist to identify TFCC foveal tear. Patients were allocated into two groups according to the presence of osteoporosis: patients with osteoporosis (group I) and those without osteoporosis (group II). Group I showed a significantly larger displacement of fractures compared to group II (radial inclination; 13.7 ± 5.4 vs. 17.9 ± 4.2; p < 0.001, dorsal angulation; 22.2 ± 12.1 vs. 16.5 ± 9.4; p = 0.024, ulnar variance; 4.15 ± 2.1 vs. 2.2 ± 1.9; p < 0.001). Dorsal angulation and ulnar variance were found to be independent prognostic factors for TFCC foveal tear in logistic regression analysis. Displacement of fractures was related to osteoporosis, and dorsal angulation and ulnar variance were independent prognostic factors for TFCC foveal tear. However, osteoporosis was not identified as a factor associated with TFCC foveal tears. Full article
(This article belongs to the Special Issue Advances in Orthopedic Trauma Surgery in Geriatrics)
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12 pages, 271 KiB  
Article
Associated Factors of Functional Ability in Older Persons Undergoing Hip Surgery Immediately Post-Hospital Discharge: A Prospective Study
by Kanokwan Monkuntod, Suparb Aree-Ue and Inthira Roopsawang
J. Clin. Med. 2023, 12(19), 6258; https://doi.org/10.3390/jcm12196258 - 28 Sep 2023
Cited by 1 | Viewed by 1550
Abstract
Background: hip fractures commonly have an impact on older adults’ health. Surgical treatment aims to reduce pain and promote functional ability. However, developing adverse health outcomes or complications post-hip surgery may impede older patients’ recovery to return to functional ability as pre-fracture. We [...] Read more.
Background: hip fractures commonly have an impact on older adults’ health. Surgical treatment aims to reduce pain and promote functional ability. However, developing adverse health outcomes or complications post-hip surgery may impede older patients’ recovery to return to functional ability as pre-fracture. We aimed to examine the association of personal factors and adverse health outcomes during hospitalization and post-hospital discharge on the functional ability of older people undergoing hip surgery. Methods: a total of 120 older people with hip fractures who were scheduled for surgery at three tertiary hospitals and met the inclusion criteria were recruited for this study. Data were obtained at admission, before discharge, and during the two-week postoperative follow-up using the Demographic, Hip Dysfunction and Osteoarthritis Outcome Score, Joint Replacement, the Confusion Assessment Method (CAM) Thai version, and Health Outcome Questionnaires. Descriptive statistics and multiple logistic regression analyses were performed to analyze the data. Results: most participants were female, with a mean age of 78.10 years (range = 60–93; SD = 8.37). The most common adverse health outcome during hospitalization was urinary tract infection, followed by delirium, pneumonia, deep vein thrombosis, and surgical site infection. At two weeks immediately post-hospital discharge, 16 participants experienced unpleasant events, including delirium, urinary tract infection, surgical site infection, and pneumonia. The significant predictors of poor functional ability at two weeks immediately post-hospital discharge were old age (OR = 1.114, p = 0.001), subtrochanteric fracture (OR = 13.48, p = 0.008), and type of surgery (OR = 4.105, p = 0.049). Full article
(This article belongs to the Special Issue Advances in Orthopedic Trauma Surgery in Geriatrics)
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