Holistic Management of Dyslipidemia in a Geriatric Patient with Comorbid Hypertension and History of Hyperuricemia Following Lower Extremity Trauma

There have been no prior case series of isolated iliac wing fracture (IIWF) due to low-energy trauma in geriatric patients in the literature. The aim of this study was to describe the characteristics of IIWF in geriatric patients, and to present a case series of IIWF in geriatric patients who underwent our minimally invasive screw fixation technique named 'iliac pillar screw fixation'. We retrospectively reviewed six geriatric patients over 65 years old who had isolated iliac wing fracture treated with minimally invasive screw fixation technique between January 2006 and April 2016. Six geriatric patients received iliac pillar screw fixation for acute IIWFs. The incidence of IIWFs was approximately 3.5% of geriatric patients with any pelvic bone fractures. The main fracture line exists in common; it extends from a point between the anterosuperior iliac spine and the anteroinferior iliac spine to a point located at the dorsal 1/3 of the iliac crest whether fracture was comminuted or not. Regarding the Koval walking ability, patients who underwent iliac pillar screw fixation technique tended to regain their pre-injury walking including one patient in a previously bedridden state. The visual analog scale score for pain at the last follow-up was quite satisfactory. Union was achieved in all patients at the last follow-up. Geriatric patients can have a form of IIWF caused by low-energy trauma that is a type of fragility fracture of the pelvis. Because subsequent deterioration of their walking status followed by a long period of non-weight bearing in geriatric patients could be as threatening as the fracture itself, the treatment paradigm for IIWF due to low-energy trauma in geriatric patients should differ from that due to high-energy trauma in most patients. In these types of fractures, minimally invasive surgical management that includes iliac pillar screw fixation can lead to good outcomes.

Radiologists play an important role in evaluation of geriatric trauma patients. Geriatric patients have injury patterns that differ markedly from those seen in younger adults and are susceptible to serious injury from minor trauma. The spectrum of trauma in geriatric patients includes head and spine injury, chest and rib trauma, blunt abdominal injury, pelvic fractures, and extremity fractures. Clinical evaluation of geriatric trauma patients is difficult because of overall frailty, comorbid illness, and medication effects. Specific attention should be focused on the effects of medications in this population, including anticoagulants, steroids, and bisphosphonates. Radiologists should use age-appropriate algorithms for radiography, computed tomography (CT), and magnetic resonance imaging of geriatric trauma patients and follow guidelines for intravenous contrast agent administration in elderly patients with impaired renal function. Because there is less concern about risk for cancer with use of ionizing radiation in this age group, CT is the primary imaging modality used in the setting of geriatric trauma. Clinical examples are provided from the authors' experience at a trauma center where geriatric patients who have sustained major and minor injuries are treated daily.

Profile of geriatric pelvic fractures presenting to the emergency department

Geriatric trauma refers to injuries sustained by elderly individuals, typically those aged 65 years and older. The management of geriatric trauma in the Emergency Department requires a comprehensive approach that takes into account the physiological changes associated with aging, as well as the increased vulnerability and complexity of injuries in this population. This is a cross-sectional study aimed at evaluating the etiology of trauma in geriatric patients referred to the ED of level-1 an academic center. All patients with complaints of trauma are evaluated and patients over 65 years enrolled in the study. Data were analyzed by SPSS 26. 319 patients were investigated, 49.8% male and 50.2% female. The most common underlying diseases are high blood pressure, diabetes type 2, and ischemic heart disease. The most common trauma cause was falling from the same level (48.9%), followed by a fall from a height (16.6%), accidents with cars (16%), and motorcycles (9.1%). The most common injury was extremities trauma (71.5%) following head trauma (13.2%) and chest trauma (6%). The severity of injury in extremities was higher in women, and chest trauma was more severe in men. The fall and subsequent car accident had the highest frequency as a cause of trauma in elderly patients admitted to our academic trauma center. Hypertension and diabetes have also been the most common underlying diseases. Head and neck injuries are life-threatening and critical in a larger number of patients than other injuries, and protecting them can be effective in reducing mortality and serious injuries in elderly trauma patients.

The geriatric population is the fastest growing segment of the population, and geriatric trauma patients are increasingly common. Caring for this population has unique challenges. The goal of the review is to identify factors that may help in the care of geriatric patients suffering from genitourinary trauma. Multiple factors lead to inferior outcomes in patients with geriatric trauma including failure to rescue, treatment in lower volume trauma centers, and undertriage of geriatric patients. Improvement in geriatric trauma outcomes occurs with the use of dedicated geriatric consult teams. The surgical management of genitourinary injuries in the geriatric population remains unchanged. Interventions for geriatric patients differ from younger populations. Direct changes in overall management of the geriatric population lead to improved outcomes. The treatment of geriatric trauma patients with genitourinary injuries is similar to a younger cohort. The lack of recent studies in clinical outcomes in this population has been identified as a gap in knowledge that will require future research to answer.

Trauma in geriatric patients (traditionally defined as adults aged 65 and older) is associated with high morbidity and mortality. Although older adults have lower average Injury Severity Scores (ISS) than younger patients, their mortality rates are higher. There are multiple hypotheses to explain these disparities; however, there is an incomplete consensus on how to best care for these patients in the prehospital setting. To address this issue, the National Association of Emergency Medical Services Physicians (NAEMSP) conducted a structured, rapid review of the literature to develop evidence-based guidance on the care of geriatric trauma patients in the prehospital setting.

Penetrating Trauma in the Elderly (65 Years and Older): An Expression of Despair

Trauma Mortality Factors in the Elderly Population

Unicondylar femoral fractures are uncommon injuries, known to occur primarily in young people, with high energy trauma. However, according to our experiences, unicondylar femoral fractures in geriatric patients generally involved the medial femoral condyle, unlike previously reported. In addition, the fractures of medial femoral condyle (FMFC) showed a characteristic fracture pattern. To date, there has been no published article focusing on the FMFC in geriatric patients. Thus, the aim of this study was to determine the characteristics of FMFC in geriatric patients and to present their outcomes. We retrospectively reviewed the medical records of 13 patients over age of 65 who underwent surgery for FMFC (AO-OTA 33B2). Of the 13, 10 patients were treated with Tomofix medial distal femoral plate (MDF) (Synthes GmbH, Switzerland) and additional screws fixation; the other three were treated with screw fixation and cast application. The mean age of patients was 76.8years, and 10 patients were females. The fracture was due to low-energy trauma in all of the cases. Eight patients had medial knee osteoarthritis, and 2 patients were on osteoporosis treatment. A characteristic fracture pattern was observed. The fracture line extended from the lateral aspect of the intercondylar notch to the posteromedial column of the distal femur, with a characteristic medial beak. All fractures belonged to AO classification 33B2.1; there were no cases of AO classification 33B2.2 or 33B2.3. The postoperative joint function was graded according to the Kolmert functional criteria: ten cases were excellent, one case was good, one case was fair, and one case was poor. FMFC caused by low-energy trauma in geriatric patients tend to have a characteristic pattern. We believe that anatomic reduction and firm fixation with Tomofix MDF plate and cannulated screw for low-energy trauma FMFC in geriatric patients would yield good outcomes.

Geriatric Trauma

The analysis aimed to quantify the number and costs of patients with type 2 diabetes and atherosclerotic cardiovascular disease or with risk factors for atherosclerotic cardiovascular disease from the Regional Health Service (RHS) perspective of the Marche region. A cost of illness (COI) model was developed to estimate the economic burden associated with diabetes and established atherosclerotic cardiovascular disease or risk factors for atherosclerotic cardiovascular disease. Data were extrapolated from the administrative database of the Marche region and specific inclusion criteria for enrolling patients were adapted from DECLARE-TIMI 58 clinical trial. RHS perspective (drugs, hospitalizations, monitoring cost) and 1 and 4-year time horizons were considered. The analysis estimated a total number of 92,205 diabetic patients in Marche region in 2014. Of these, 66,306 were patients (5.9% of the resident population) with established atherosclerotic cardiovascular disease (13,104 patients) or risk factors for atherosclerotic cardiovascular disease (53,202 patients). The annual expenditure associated with patients analysed amounted to € 98.8 million (average cost per patient € 1,480) in Marche region. Of these, 52% was associated with hospitalizations. Considering a 4-year time horizon, the overall economic burden rises to over € 301 million per year with an average cost per patient of € 4,545. Stratifying patients between patients hospitalized for heart failure and patients not hospitalized for heart failure, the average annual cost per patient was equal to € 15,896 and equal to € 3,998 respectively. An important epidemiological and economic burden associated with type 2 diabetes patients were estimated from the analysis due to the disease and the associated comorbidities. The ability to prevent comorbidity risks, especially cardiovascular ones, represents not only a clinical advantage but also a positive reduction in expenditure. Early and effective intervention represents the best strategy to avoid or slow down the evolution of complications of the disease.

Background: High-sensitivity C-reactive protein (hsCRP) is a well-established biomarker of inflammation. Systemic inflammation is a recognized risk factor for atherosclerotic cardiovascular disease (ASCVD); however, the prevalence of systemic inflammation (SI) and the associated patient characteristics remain unknown. Aim: To define the prevalence and clinical characteristics of patients with SI and ASCVD with or without chronic kidney disease (CKD). Methods: A retrospective cross-sectional analysis of US adults (aged ≥18 years) with any diagnoses of ASCVD evaluated with a hsCRP test using the Optum® de-identified electronic health record dataset between 2017 and 2021. SI was defined as an hsCRP level of 2–10 mg/L. The prevalence of SI was evaluated by calendar year, stratified to three groups by presence of ASCVD, ASCVD with any stage of CKD, and ASCVD with stage 3 or 4 CKD. Concomitant comorbidities and medications used were assessed and stratified by CKD severity. Results: Across the study period, prevalence of hsCRP testing among patients with ASCVD remained relatively stable (0.87–0.98%). Among patients who underwent hsCRP testing, SI was present in 38.0%, 42.3% and 51.5% of patients with ASCVD, ASCVD with CKD, and ASCVD with stage 3 or 4 CKD averaged across the study period, respectively (Figure 1). The prevalence of SI remained largely unchanged over the study period across the three groups (Figure 1). Among those with SI, a higher Charlson Comorbidity Index was noted in those with CKD: 0.75–0.78 in those with ASCVD, 0.99–1.21 in those with ASCVD and CKD, and 1.71–1.89 in those with ASCVD and stage 3 or 4 CKD. The most common medications utilized in those with SI were lipid-lowering therapy (70.5% [ASCVD], 72.7% [ASCVD with any CKD] and 75.4% [ASCVD with stage 3 or 4 CKD]) and antihypertensive therapy (72.8% [ASCVD], 79.3% [ASCVD with any CKD] and 86.7% [ASCVD with stage 3 or 4 CKD]) averaged across the study period. Conclusion: Among patients with ASCVD undergoing hsCRP testing, SI was common, particularly among those with stage 3 or 4 CKD. This finding may help identify at-risk individuals who are likely to benefit from treatment of SI.

Objective: Head trauma is one of the most common causes of emergency admission in elderly patients. The risk of intracranial pathology increases after trauma due to the weakening of bone structures, deterioration in blood parameters, and use of anticoagulants. This study aimed to examine the factors affecting mortality after head trauma in geriatric patients. Material and Methods: Geriatric patients who were admitted to the emergency department with head trauma between 01.01.2015 and 31.12.2015 and underwent cranial computed tomography (cCT) were included in the study. Patient data were analyzed according to gender, age groups, trauma causes, hematological parameters and hospitalization-discharge status. Results: 320 patients were included in the study, 169 were female (52.8%), and 142 were in the 65-74 age group (%44). Intracranial pathology was detected in 34 patients. The most common causes of trauma were falls and traffic accidents. The most common CT pathology was subdural hemorrhage. 76 (24%) of 320 patients were hospitalized. As their final status, 307 patients were discharged (96%), 6 were transferred (1.9%), 7 died (2.2%). Conclusion: In the study, there is no significant correlation between age, gender, mechanism of trauma, hematological parameters and mortality in geriatric head trauma. Geriatric head traumas must be evaluated seriously regardless of the mechanism of injury, age and gender groups, even simple traumas can be dangerous.

Background: Lipoprotein(a) [Lp(a)] is a causal, predominantly genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD). Approximately 20-30% of the global population have Lp(a) levels in the atherogenic range, with prospective data demonstrating a dose-response association of Lp(a) levels with ASCVD risk. However, there are relatively limited data characterizing the relationship between Lp(a) and premature ASCVD in epidemiologic cohort studies. Methods: We evaluated participants in the ARIC study with available Lp(a) measurements, collected at ARIC Visit 4 (1996-98). We used continuous follow-up and adjudication for ASCVD events (nonfatal myocardial infarction, fatal coronary heart disease, or ischemic stroke) from 1987 through 2021 to categorize participants as having had premature ASCVD events (events by age <55 for men, <65 for women), non-premature ASCVD events (age ≥55 for men, ≥65 for women), or no ASCVD events. Lp(a) levels were categorized according to previously established cutpoints: <30, ≥30 to <50, ≥50 to <100, and ≥100 mg/dL and compared across those with non-premature ASCVD, premature ASCVD, and no ASCVD. Elevated Lp(a) was defined as ≥30 mg/dL, and multivariable-adjusted logistic regression models were used to assess the association of elevated Lp(a) with ASCVD status. Results: Among 8,236 participants (mean age 58 yrs, 71% female, 24% Black adults), those with premature ASCVD had the highest median Lp(a) levels (17.7 mg/dL), followed by non-premature ASCVD (14.4 mg/dL), and no ASCVD (13.6 mg/dL) (p = 0.002) ( Table ). Elevated Lp(a) levels were found in 40.8% of participants with premature ASCVD, compared with 34.1% in non-premature ASCVD, and 30.8% without ASCVD (p <0.001). Participants with premature ASCVD had the highest odds of elevated Lp(a) relative to those with no ASCVD (OR: 1.39 [95% CI: 1.09-1.77]), while participants with non-premature ASCVD had a lesser, but still significantly higher odds of elevated Lp(a), compared to those with no ASCVD (OR: 1.16 [1.02-1.31]). Conclusion: Among ARIC study participants, premature ASCVD is associated with the highest prevalence and odds of elevated Lp(a). These findings reinforce the importance of the broader adoption of current guidelines that recommend systematic screening for elevated Lp(a) among individuals with premature ASCVD.

Prevalence and clinical characteristics of patients with hsCRP testing and test-confirmed systemic inflammation among individuals with atherosclerotic cardiovascular disease with or without chronic kidney disease in the United States (PLUTUS).