Fractures In Elderly Patients Research Articles

Analysis of one-year postoperative mortality and risk factors of elderly patients with intertrochanteric fractures after PFNA.

Intertrochanteric fracture is very common in elderly patients, It is one of the main reasons for the elderly to be hospitalized, and is closely related to the mortality rate. With the speeding up of the population aging, the treatment of intertrochanteric fracture is becoming more and more significant. PFNA (Proximal femoral nail antirotation) is the most commonly used surgical method, although the surgical technique has improved a lot, the postoperative mortality rate after one year is still high. If we can take active and effective control measures against the high-risk factors affecting mortality in time, it will help to improve the prognosis. To study the 1-year postoperative mortality rate of elderly patients with intertrochanteric fractures after being treated with proximal femoral nail antirotation (PFNA) and its influencing factors. The data of patients with intertrochanteric fracture treated by PFNA in our hospital during the period from August 2016 to April 2020 were retrospectively studied, and the data of age, sex, type of fracture, preoperative comorbid diseases, American Society of Anesthesiology (ASA) score, the timing of the operation, duration of operation, preoperative and postoperative hemoglobin levels, albumin level, and postoperative complications were collected through medical records, and the survival rate of patients in 1 year after operation was investigated by telephone follow-up, and single-factor analysis was carried out to analyze related influencing factors. A total of 80 patients with complete data were followed up for 1-23 months (mean 12.5 months), and totally 22 patients died within 1 year, the mortality rate was 27.5%. Single analysis results suggested that the differences in factors such as age, number of preoperative combined diseases, ASA score, preoperative and postoperative albumin levels, and postoperative complications between the survival group and the death group were statistically significant (P < 0.05). The risk factors affecting long-term death in the treatment of intertrochanteric fractures in elderly patients with PFNA shall be taken into consideration fully, and the improvement of preoperative and postoperative health status will help to reduce the postoperative mortality and improve the efficacy of surgery.

Treatment of oromaxillofacial fracture in elderly: A literature review

Maxillofacial fracture in elderly patients mostly related to age-related changes and systemic pathologic conditions. However, traumatic injuries in the elderlyhave been increasing in recent years; this is due to increased active life span with advances in medicine that result in a higher percentage of older people in the population. This article ia a review of oromaxillofacial frac-ture in elderly that published since the last 10 years obtained through the search of the electronic database PubMed and Google Scholar, then selected as many as six studies based on the treatment of oromaxillofacial fracture in elderly. Based on the selec-ted literature that has been reviewed, falls were responsible for the majority of fractures in the elderly group. The fracture loca-tions are varied but mostcommon site is zygomatic complex, nasal bone, and condylar. The results of this literature review high-light that majority of elderly patients are treated without surgical procedures.It is concluded that the treatment of maxillofacial trauma in elderly patients is often challenging, as elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment.

Reverse shoulder arthroplasty vs. hemiarthroplasty for the treatment of osteoporotic proximal humeral fractures in elderly patients: A systematic review and meta‑analysis update.

The present meta-analysis was conducted to compare the safety and effectiveness of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in the treatment of osteoporotic proximal humeral fractures in elderly patients. The Embase, Pubmed Central, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses, Cochrane Library and Chinese Biomedical databases were searched between January 2009 and January 2022 to identify relevant studies. According to the search strategy, a total of 210 associated studies were retrieved and 16 were finally included. Review Manager 5.4 software was used for the data analysis. This study indicated that patients in the RSA group had significantly improved treatment outcomes compared with patients in the HA group, as assessed by Constant-Murley Shoulder Outcome Score (95% CI, 1.69-3.76; P<0.001), American Shoulder and Elbow Surgeons score (95% CI, 11.81-24.88; P<0.001) and shoulder range of motion (ROM; 95% CI, 3.41-9.07; P<0.001). However, the HA group was superior to the RSA group in terms of the Oxford Shoulder score (95% CI, 2.89-11.11; P<0.001). There was no significant statistical difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand score and complications. Overall, for the treatment of osteoporotic proximal humeral fractures in the elderly, the RSA group had improved postoperative ROM and functional scores compared with the HA group, without significant difference in the incidence of complications. However, HA remains a safe and reliable treatment option.

A multicenter study of 1-year mortality and walking capacity after spinal fusion surgery for cervical fracture in elderly patients

BackgroundThe 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older.MethodsThree hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients’ backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted.ResultsOne year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively.ConclusionsThe 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.

Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease.

Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange.

Surgical treatment for acute and displaced proximal humerus fractures in elderly patients: hemiarthroplasty vs. reverse shoulder arthroplasty

BackgroundProximal humerus fractures (PHFs) are the third most common fractures in elderly patients. The best treatment option on this population is still a topic of discussion. Reverse shoulder arthroplasty (RSA) has increased popularity as a viable treatment option for these fractures. Yet, few studies demonstrate the risk factors for mortality after this procedure. MethodsThe authors present a retrospective study including patients older than 75 y with acute and displaced PHFs primarily treated with RSA or hemiarthroplasty in a public hospital between January 2004 and January 2020. The exclusion criteria were pathologic fractures and more than 6 weeks to surgery. Survival curves were obtained using the Kaplan-Meier method and the log-rank test was performed to compare survival rates. ResultsA total of 73 patients met the inclusion criteria. The mean age at the time of fracture and surgery was 78 y old, 10 males and 63 females, with a median clinical follow-up of 64 months (standard deviation 34). Forty-one patients (56%) had an American Society of Anesthesiologists score of 2. Twenty-eight patients were submitted to hemiarthroplasty and 45 to RSA. Regarding hemiarthroplasty, only one patient with hemiarthroplasty died within a year, and the 5 y survival rate was 70%. Concerning to RSA group, five patients died within a year, and the survival rate at 5 y was 66.2 %. The American Society of Anesthesiologists score (P < .001) was the only risk factor identified for mortality at 5 y. Hemiarthroplasties had more prosthetic loosening compared with RSA (P = .024). Three hemiarthroplasties were converted to RSA, and we verified 1 RSA infection. In the group of hemiarthroplasties, 56% returned to their normal daily living activities, while in the RSA 92% did that, representing a significant difference (P = .007). ConclusionRSA as a primary treatment for displaced PHFs had a high survival rate (88.9% at 1 year and 66.2% at 5 y) and better functional results comparing to patients treated with hemiarthroplasty. With proper patient selection, RSA is a safe procedure for the treatment of PHF, especially in an elderly population.

A prospective study comparing the efficacy of proximal femoral nail antirotation device with dynamic hip screw fixation in management of unstable pertrochanteric fractures

Background: Pertrochanteric femoral fracture is the most common fractures of the hip especially in the elderly patients with osteoporotic bone, usually due to low-energy trauma like simple falls. Dynamic hip screw (DHS) is still considered the gold standard for treating such factures. Not many studies compare DHS with Proximal Femoral Nail Antirotation (PFNA). We try to compare the efficacy of PFNA with DHS in management of unstable pertrochanteric factors. Aims and Objectives: We aimed to evaluate and compare the clinical and functional outcomes of DHS and PFNA treatment of unstable pertrochanteric femoral fractures in elderly patients. Materials and Methods: This study was a prospective study which included total of 39 patients, 25 patients treated with PFNA and 14 patients with DHS. The study was conducted in Manipal Teaching Hospital from March 1, 2019, to August 1, 2021. All the patients were clinically evaluated and detail history was obtained. After the anesthesia clearance, the patients were operated. Length of skin incision, operating time, intraoperative blood loss, and complications were noted. Postoperatively, the duration of hospital stay, time of partial and full weight-bearing, time for radiological union, and complications were noted. Functional outcome was assessed using Harris hip score at 3 months and 6 months follow-up. Results: The mean age of the patient in this study was 74.68 years for PFNA and 75.57 years for DHS. The average time to complete the surgery was 71 min for PFNA and 92.86 min for DHS. The average blood loss was 162 ml for PFNA and 403 ml for DHS which was found to be statically significant. Partial weight-bearing on axillary crutches was started at the mean time of 3.7 weeks for PFNA and 8.1 weeks for DHS, whereas full weight-bearing was done at the mean of 8.2 weeks for PFNA and 12.1 weeks for DHS. Radiological union was seen at the average of 18.72 weeks for PFNA and 20.14 weeks for DHS which was not statically significant. The mean Harris Hip score at 3 months and 6 months follow-up was 63.84 and 88 for PFNA and 48.50 and 81.43 for DHS, respectively, which showed significantly better result with PFNA. Conclusion: Compared to DHS treatment, PFNA treatment in unstable pertrochanteric femoral fracture is associated with reduced blood loss, shorter operative time, and hospital stay with few intraoperative and post-operative complication. Post-operative rehabilitation with the early mobilization and return to pre-injury status was better with PFNA.

Timing of artificial femoral head replacement in the treatment of femoral intertrochanteric fracture with intramedullary nail failure in elderly patients

To analyze the timing of artificial femoral head replacement in elderly patients with femoral intertrochanteric fracture after intramedullary nail failure. From July 2013 to September 2019, 17 elderly patients with femoral intertrochanteric fracture after intramedullary nail fixation failure were treated with artificial femoral head replacement. According to the interval from diagnosis of internal fixation failure to pedestrian femoral head replacement, the patients were divided into early operation and delayed operation groups. Among them, there were 8 cases of early operation, 5 males and 3 females;the age ranged from 80 to 89 years old with an average of (84.88±2.79) years old;the interval was 1 to 7 days with an average of(4.13±1.73) d. There were 9 cases of delayed operation, 4 males and 5 females;the age ranged from 80 to 89 year old with an average of(84.22±3.03) years old;The interval was 15 to 30 with days an average of (25.56±4.36) d. The operation time, intraoperative blood loss, the first postoperative weight-bearing time, postoperative hospital stay, the number of complications and deaths were compared between two groups. Harris score was used to evaluate hip function at 1 and 12 months after operation. The incision healed well after operation. There was 1 case of urinary tract infection in the early operation group;in the delayed operation group, there were 2 cases of intermuscular venous thrombosis, 1 case of pulmonary infection, 3 cases of urinary tract infection and 1 case of prosthesis dislocation. All 17 patients were followed up for 12 to 16 months with an average of (14.76±1.86) months. There was no significant difference in operation time, intraoperative blood loss and the number of deaths between two groups(P>0.05). There were significant differences in the first weight-bearing time, postoperative hospital stay and the number of complications between two groups(P<0.05). One month after operation, there was significant difference in Harris score between two groups(P<0.05). There was no significant difference in Harris score between two groups 12 months after operation(P>0.05). After the failure of intramedullary nail fixation of femoral intertrochanteric fracture in elderly patients, there is no significant difference in mortality and final hip function between early operation and delayed operation. However, early pedestrian femoral head replacement can make patients go down to the ground earlier, shorten the length of hospital stay, effectively reduce the complication rate and restore hip function as soon as possible.

A Study to Assess Outcome of Hip Fractures in Elderly Patients with Associated Hyponatraemia and Review of Literature

A Study to Assess Outcome of Hip Fractures in Elderly Patients with Associated Hyponatraemia and Review of Literature

Outcome analysis of coxo-femoral bypass for intertrochanteric fracture femur in elderly patients

In this study, we have tried to find and analyse the outcome of coxofemoral bypasss in intertrochanteric fractures which were operated at a tertiary care hospital in Bhopal, M.P., India and completed the follow up till 12 months. These patients were analysed on various intra-operative and post-operative parameters. Functional assessment was done using Harris Hip Score. Harris Hip Score showed that 04(20%) patients had excellent results, 08 (40%) patient had good results, 04(20%) patients had fair and 02(10%) had poor results. Poor results were seen in patients with multiple co-morbidities. This study indicates that coxofemoral bypass for intertrochanteric fractures in elderly patients has shown to achieve early rehabilitation and good long-term results.

Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making

IntroductionPelvic ring fractures in the elderly are often caused by minor trauma. Treatment of these patients is currently based on fracture classification, clinical course, and ability to mobilize. Our aim was to identify morphological fracture characteristics with potential prognostic relevance and evaluate their association with clinical decision making and outcome, as well as their interobserver reliability.MethodsFive fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Presence of a horizontal sacral fracture; 4. Ventral dislocation; 5. Ventral comminution.These characteristics were assessed retrospectively in a series of 548 patients. The association of their presence with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Further, the inter-observer reliability for the specific characteristics was calculated and the relation with survival assessed.ResultsFour of the five evaluated characteristics showed an association with clinical decision making and patient management. In particular the extent of the dorsal fractures (absent vs. unilateral vs. bilateral) (OR = 7.0; p < 00.1) and the presence of ventral comminution/dislocation (OR = 2.4; p = 0.004) were independent factors for the decision to perform surgery. Both the extent of the dorsal fracture (OR = 1.8; p < 0.001) and the presence of ventral dislocation (OR = 1.7; p = 0.003) were independently associated with a prolonged overall LOS.The inter-observer agreement for the fracture characteristics ranged from moderate to substantial.A relevant association with increased mortality was shown for horizontal sacral and comminuted ventral fractures with hazard ratios (HR) of 1.7 (95% CI: 1.1, 2.5; p = 0.008) and HR = 1.5 (95% CI: 1.0, 2.2; p = 0.048).ConclusionIn the elderly, the extent of the dorsal fractures and the presence of ventral comminution/dislocation were associated to the decision to undergo surgery, failure of conservative treatment and length of stay. Survival was related to horizontal sacral fractures and ventrally comminuted fractures. These characteristics thus represent a simplified but highly informative approach for the evaluation of pelvic ring fractures in the elderly. This approach can support clinical decision making, promote patient-centred treatment algorithms and thus improve the outcome of individualized care.

Application Effect of Nursing Logo in Nursing Risk Management of Elderly Fracture Patients

Application Effect of Nursing Logo in Nursing Risk Management of Elderly Fracture Patients

Management of Open Ankle Fractures in Elderly Patients With a Fibula Nail is a Safe and Reliable Technique.

Ankle fractures are becoming more common in the elderly and their management is frequently challenging. There is increasing evidence of good outcomes following fibula nail fixation in the management of ankle fractures. The use of a fibula nail in open fractures comes with potential advantages such as minimal soft tissue dissection, early rehabilitation, and decreased wound complications. We aimed to assess their use in the management of open ankle fractures in the elderly. A review of patients aged 60 years or older with an open ankle fracture treated with a fibular nail at a major trauma center was conducted. All patients were managed with joint Orthopaedic and Plastic Surgical input to determine their optimal management. Functional outcome scores, postoperative complications, and re-operation rates were determined. Fifteen patients were identified with a mean age of 76 years. Patient-reported outcomes (Olerud and Molander Score) were calculated in 73% of patients. Our results demonstrated excellent outcome scores (>91) in 1 patient, good outcome scores (61-90) in 7 patients, and fair outcome scores (31-60) in 3 patients. There were no postoperative complications or re-operations within our study group. This article is the largest series presenting the outcomes of fibula nails in the management of open ankle fractures in elderly patients. We conclude that it can be used as a treatment option to safely manage open ankle fractures in the elderly. It provides a stable fixation, early weight-bearing, low risk of postoperative complications while maintaining good patient-reported functional outcomes. Level 4.

Is Cemented Bipolar Hemiarthroplasty Good Choice For Unstable Intertrochanteric Fractures In Elderly: Multicentric Prospective Study At Karachi.

To analyse the functional outcome of primary cemented bipolar hemi arthroplasty (PCBH) for unstable osteoporotic intertrochanteric femur fractures in elderly patients. : It was a multicentre prospective study conducted at Institute of Orthopaedics & Surgery, Medicare Cardiac & General Hospital and Dr Ruth K M Pfau Civil Hospital Karachi, Pakistan from February 2015 to July 2020. Thirty-eight patients of 60-90 years of either gender diagnosed as close UIF, severe osteoporosis as per Singh index grade ≤3, time since injury <2 weeks, ASA status II & III and pre-injury independent walking were enrolled in this study. All patients with UIF underwent PCBH. The radiographs were performed before surgery and at intervals postoperatively. All patients were requested to come for follow up visits at 2 weeks, 4 weeks, 3 months, 6 months 1 year and then at 3 years to assess the functional outcome of patients. At first postoperative day check X-rays taken and rehabilitation started as per institutional rehabilitation protocol, at 2-week stiches removed, at 4 weeks' x-ray was done and all the patients were followed for 3 years. The primary outcomes were noted using Harris Hip Score (HHS) for the functional outcome assessed at the end of 1 year and at final follow up. The mean age of the study participants was 68.29±8.04 years. One male (2.6%) died at 6th month, then 2 females (5.2%) patients died at 1 year and 2 females (5.2%) patients died at the end of 3 years due to multiple comorbid conditions. During 1st year 3 patients (7.4%) developed DVT and 4 patients (10.5%) having diabetes and hypertension developed superficial wound infection. The mean Harris Hip Score between time points which indicated that the mean Harris Hip Score significantly improve over the period of time (p=0.001). Post hoc tests revealed that there were statistically significant differences between each time points (p<0.05). The functional outcome at 3 years, shown, one patient had excellent outcome, 24 patients had good outcome and 8 had fair outcome, respectively. The Primary Cemented Bipolar Hemiarthoplasty is a good choice of treatment in terms of reasonable functional outcome such as early mobilization and associated with less post-operative complications in elderly patients of UIF.

Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture.

The incidence rate of lower limb fractures is high and has increased over the recent years, which affects the physical and mental health and the daily activities of patients. Lower limb fractures are often treated surgically. Therefore, an effective anesthesia regimen is crucial for a smooth and stable operation. To investigate the efficacy of posterior lumbar plexus block anesthesia during surgery for elderly patients with lower extremity fractures. In total, patients were divided into study and control groups. Anesthesia was administered by posterior lumbar plexus nerve block in the study group and epidural anesthesia in the control group. Hemodynamic parameters, anesthesia condition, pain level (VAS), and adverse effects were measured in both groups before anesthesia (T0), at anesthesia induction (T1), 30 min into the operation (T2), and at the end of the operation (T3). At T0, there were no significant differences in MAP and HR between the study and control groups. However, MAP and HR in the study group were significantly lower than those in the control group at T1, T2, and T3. The BIS value of the study group at each time point after anesthesia was significantly lower than that of the control group. The onset and induction time of anesthesia in the study group were also significantly shorter than those in the control group. Preoperative VAS scores did not differ between the study and control groups. However, the VAS scores of the study group at each time point were significantly lower than those of the control group. There was no significant difference in the incidence of adverse reactions between the two groups. Our results suggest that anesthesia with posterior lumbar plexus block surgery for lower extremity fractures in elderly patients can maintain hemodynamic stability and reduce block onset time, anesthesia induction time, and pain.

Clinical Study on Minimally Invasive Treatment of Distal Radius Fractures in Elderly Patients

Clinical Study on Minimally Invasive Treatment of Distal Radius Fractures in Elderly Patients

Factors influencing surgical management of proximal humerus fractures: do shoulder and trauma surgeons differ?

Proximal humerus fractures (PHFs) are managed with open reduction and internal fixation (ORIF), hemiarthroplasty (HA), reverse shoulder arthroplasty (RSA), or nonoperatively. Given the mixed results in the literature, the optimal treatment is unclear to surgeons. The purpose of this study was to survey orthopedic shoulder and trauma surgeons to identify the patient- and fracture-related characteristics that influence surgical decision-making. We distributed a 23-question closed-response email survey to members of the American Shoulder and Elbow Surgeons and Orthopaedic Trauma Association. Questions posed to respondents included demographics, surgical planning, indications for ORIF and arthroplasty, and the use of surgical augmentation with ORIF. Numerical and multiple-choice responses were compared between shoulder and trauma surgeons using unpaired t-tests and χ2 tests, respectively. Respondents included 172 shoulder and 78 trauma surgeons. When surgery is indicated, most shoulder and trauma surgeons treat 2-part (69%) and 3-part (53%) PHFs with ORIF. Indications for managing PHFs with arthroplasty instead of ORIF include an intra-articular fracture (82%), bone quality (76%), age (72%), and previous rotator cuff dysfunction (70%). In patients older than 50 years, 90% of respondents cited a head-split fracture as an indication for arthroplasty. Both shoulder and trauma surgeons preferred RSA for treating PHFs presenting with a head-split fracture in an elderly patient (94%), pre-existing rotator cuff tear (84%), and pre-existing glenohumeral arthritis with an intact cuff (75%). Similarly, both groups preferred ORIF for PHFs in young patients with a fracture dislocation (94%). In contrast, although most trauma surgeons preferred to manage PHFs in low functioning patients with a significantly displaced fracture or nonreconstructable injury nonoperatively (84% and 86%, respectively), shoulder surgeons preferred either RSA (44% and 46%, respectively) or nonoperative treatment (54% and 49%, respectively) (P<.001). Similarly, although trauma surgeons preferred to manage PHFs in young patients with a head-split fracture or limited humeral head subchondral bone with ORIF (98% and 87%, respectively), shoulder surgeons preferred either ORIF (54% and 62%, respectively) or HA (43% and 34%, respectively) (P<.001). ORIF and HA are preferred for treating simple PHFs in young patients with good bone quality or fracture dislocations, whereas RSA and nonoperative management are preferred for complex fractures in elderly patients with poor bone quality, rotator cuff dysfunction, or osteoarthritis. The preferred management differed between shoulder and trauma surgeons for half of the common PHF presentations, highlighting the need for future research.

Treatment of Odontoid Fractures in Elderly Patients Using C1/C2 Instrumented Fusion Supplemented With Bilateral Atlantoaxial Joint Spacers: A Case Series.

Spinal fractures are among the most common traumatic injuries in elderly patients, with the odontoid process being frequently affected. As this patient group usually has high rates of comorbidity and chronic diseases, a nonoperative approach may offer a reasonable solution for a favorable fracture pattern. We modified the procedure by implanting a bilateral atlantoaxial joint spacer (model DTRAX) into the joint space and review our experience utilizing this technique for the treatment of patients with a fracture of the odontoid process. A retrospective evaluation was performed on patients treated surgically for unstable traumatic fractures of the odontoid process. The stabilization was performed using a dorsal rod and screw instrumentation of the lateral mass of the atlas and the pars interarticularis of the axis. The procedure was further modified by implanting a bilateral atlantoaxial joint spacer (DTRAX) into the joint space bilaterally after the removal of the articular cartilage. Patients older than 70 years with a traumatic fracture of the odontoid process were included. Pain was assessed pre- and postoperatively using the visual analog scale (VAS). To verify fusion during follow-up, either x-ray imaging of the cervical spine or magnetic resonance imaging or computed tomography were performed. A total of 5 patients were included in our study. Four patients had an American Society of Anesthesiology score of 3 and 1 had a score of 4. The average duration of surgery was 187 ± 38.1 minutes. The average blood loss during the procedure was 340 ± 270 mL. The average radiological follow-up period was 21.2 ± 17.5 months. Preoperatively, the average VAS pain score was 2.3 ± 3.3. Postoperatively, the mean VAS decreased to 0.6 ± 0.9. The average follow-up period for pain was 27.2 ± 19 months. No patient showed neurological deficits before or after surgery. Follow-up demonstrated solid fusion in all cases. The fusion of the atlantoaxial joint with bilateral atlantoaxial joint spacers represents a suitable and feasible option for achieving high fusion rates in elderly patients with odontoid fractures. A significant percentage of patients who are treated non-operatively will experience nonunion, which may cause instability of the atlantoaxial joint. Posterior fixation with screws and rods is a treatment option, but it leaves the cartilaginous joint surface in place, which can be an impediment to the fusion process. In other cases, degenerative collapse of the C1/C2 joint can cause compression of the C2 nerve root.

Intracapsular Femoral Neck Fractures in the Elderly.

Currently, intracapsular femoral neck fracture (IFNF) is still a great challenge for orthopedists. In spite of the progress that has been made, a high mortality rate persists in the first year, especially in Brazil, where there is no awareness that such fractures in elderly patients should be treated as a medical emergency. The present article seeks to provide an update on the preoperative, surgical, and postoperative approaches.

Conservative treatment versus reversed shoulder prothesis for proximal humerus fractures in the elderly: A meta-analysis of observational studies and randomised clinical trials

Abstract Objective The treatment of complex proximal humerus fractures in elderly patients is not yet fully eluci-dated. Of all treatment options reverse shoulder arthroplasty (RSA) and non operative treat-ment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus non-operative treatment. Methods Studies comparing RSA and NOT were included for direct comparison by systematic re-view and pooled analysis for patient rated outcome and range of motion. Additionally, indirect comparison of case-series and non-comparative studies on either treatment modalities was performed separately. Results Comparative: Reverse shoulder arthroplasty resulted in better patient rated outcome scores and better range of motion. Pain and treatment satisfaction scores were better after RSA. Non comparative studies reported similar patient rated and range of motion scores for both RSA and after NOT. Conclusion The functional and range of motion outcomes after RSA seem satisfactory and potentially superior to NOT in elderly patients. The complication rate is acceptably low and an overall revision rate of 5% was found. These results should however be viewed in light of distinct differences in patient characteristics between treatment groups.