Hip and Fragility Fracture Management
A special issue of Medicina (ISSN 1648-9144).
Deadline for manuscript submissions: closed (1 October 2021) | Viewed by 61124
Special Issue Editor
2. Medical Faculty, University of Zurich, Zurich, Switzerland
3. RWTH Aachen University Hospital, Aachen, Germany
Interests: anchorage strategies in geriatric hip fracture management; fragility fracture; fall prevention; ortho-geriatric co-management; geriatric trauma center; medical education; biomechanical investigations; microcirculation
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Special Issue Information
Dear Colleagues,
Geriatric trauma care is gaining more importance due to demographic changes. This growth in geriatric trauma patients presents a great challenge for the treating physicians. In addition to poor bone quality, which makes (operative) fracture fixation more difficult, comorbid conditions often lead to perioperative complications and hamper rehabilitation. Considering all these factors, geriatric trauma has great social and economic implications.
Surgical treatment should be straightforward and less invasive, allow immediate weight-bearing, and should be associated with a low complication rate. Various factors, such as patient age, comorbidities, activity level, age of the fracture or pre-injury arthrosis, and experience of the surgeon influence the decision-making for fixation. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender) and surgeon-related factors (experience, correct reduction, and optimal screw placement). Fracture reduction and implant positioning are directly related, with correct reduction being the prerequisite to correct implant placement. However, in recent years, cement augmentation strategies came to the fore and were discussed to an increasing degree.
The 1-month mortality rate after hip fracture ranges from 4% to 12% and reaches up to 35% after 1 year. The hip fracture patient frequently presents with complex comorbidities, including but not limited to impaired hepatic and renal function, diabetes mellitus, dementia, delirium, coronary artery disease, heart failure, and patient polypharmacy. These are all individually linked to an increase in postoperative complications and mortality. Hip fractures create substantial needs for informal caregiving and postacute and long-term care that carry major costs to society.
However, the incidence of falls in the elderly population is difficult to determine, and therefore potentially underestimated. Previous falls, strength, gait and balance impairments, and use of specific medications range amongst the strongest predictors. Indication from the literature suggests that older adults tend not to be sufficiently aware of their potential for falls or their fall risk. In addition, the literature suggests that client outcomes vary with the type of treatment prescribed, the equipment of the clinic, and the health professional’s abilities.
The purpose of this Special Issue is to discuss the evidence for the fixation/prosthetic treatment of femoral neck fractures, as well as trochanteric and subtrochanteric fractures in elderly patients. The scope of the Issue is deliberately broad in order to encourage the coverage of a wide range of topics and perspectives related to the management of hip fractures. This includes not only clinical treatments but also biomechanical considerations regarding implant anchorage, patient experience, epidemiology, service delivery, health promotion, complex co-management strategies in geriatric fracture care including fall prevention, and new interdisciplinary developments like the installation of a fracture liaison service or a geriatric fracture center.
Prof. Dr. Matthias Knobe
Guest Editor
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Keywords
- hip fracture
- fracture fixation
- implant anchorage
- cement augmentation
- co-management
- fragility fracture
- comorbidity
- fall prevention
- biomechanical investigation
- geriatric fracture center
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