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Abstract

Orthopedic injuries in the elderly are a major challenge in geriatric medicine. This rapidly growing segment of the population sustains a disproportionate number of fractures and, more than other age groups, requires treatment tailored to the needs of the entire patient, not just the fracture itself. As with all orthopedic care, the goal of treatment in the elderly is to restore or improve on their preinjury level of function. However, a fracture superimposed on the combination of preexisting physical infirmities and systemic medical problems often makes for a tenuous ability to maintain independent living status. Immobilization of an extremity or dependence, even temporarily, on a walker or crutches can render a patient unable to manage independently and so require institutional care. Consideration of this point is mandatory when planning the treatment of any orthopedic injury in the elderly.

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References

  1. Loder RT. The influence of diabetes on the healing of closed fractures. Clin Orthop 1988;232:210–216.

    PubMed  Google Scholar 

  2. Davis FM, Woolner DF, Frampton C, et al. Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth 1987;59:1080–1088.

    Article  PubMed  CAS  Google Scholar 

  3. Valentin N, Lomholt B, Jensen JS, Hejgaard N, Kreiner S. Spinal or general anaesthesia for surgery of the fractured hip? Br J Anaesth 1986;58:284–291.

    Article  PubMed  CAS  Google Scholar 

  4. Lane JM, Vigorita VJ. Osteoporosis. J Bone Joint Surg Am 1983;65:274–278.

    PubMed  CAS  Google Scholar 

  5. Aaron JE, Gallagher JC, Anderson J, et al. Frequency of osteomalacia and osteoporosis in fractures of the proximal femur. Lancet 1974;1:229–233.

    Article  PubMed  CAS  Google Scholar 

  6. Jenkins DHR, Roberts JG, Webster D, Williams EO. Osteomalacia in elderly patients with fracture of the femoral neck: a clinico-pathological study. J Bone Joint Surg Br 1973; 55:575–580.

    PubMed  CAS  Google Scholar 

  7. Wilton TJ, Hosking DJ, Pawley E, Stevens A, Harvey L. Osteomalacia and femoral neck fractures in the elderly. J Bone Joint Surg Br 1987;69:388–390.

    PubMed  CAS  Google Scholar 

  8. Frandsen PA, Kruse T. Hip fractures in the county of Funen, Denmark: Implications of demographic aging and changes in incidence rates. Acta Orthop Scand 1983;54:681–686.

    Article  PubMed  CAS  Google Scholar 

  9. Praemer A, Fumer S, Rice DP (eds). Musculoskeletal Conditions in the United States 1992. Rosemont, IL: American Academy of Orthopaedic Surgeons.

    Google Scholar 

  10. Brody JA. Commentary: prospects for an ageing population. Nature 1985;315:463–466.

    Article  PubMed  CAS  Google Scholar 

  11. Greenspan SL, Meyers ER, et al. Fall severity and bone mineral density as risk factors for hip fractures in ambulatory elderly. JAMA 1994;271:128–133.

    Article  PubMed  CAS  Google Scholar 

  12. Hinton RY, Smith GS. The association of age, race, and sex with the location of proximal femoral fractures in the elderly. J Bone Joint Surg Am 1993;75:752–759.

    PubMed  CAS  Google Scholar 

  13. Hinton RY, Lennox DW, et al. Relative rates of fracture of the hip in the United States. J Bone Joint Surg Am 1995; 77:695–702.

    PubMed  CAS  Google Scholar 

  14. Garraway WM, Stauffer RN, Kurland LT, O’Falba WM. Limb fractures in a defined population. I. Frequency and distribution. Mayo Clin Proc 1979;54:701–707.

    PubMed  CAS  Google Scholar 

  15. Johnell O, Sernbo I. Health and social status in patients with hip fractures and controls. Age Ageing 1986;15: 285–291.

    Article  PubMed  CAS  Google Scholar 

  16. Uden G, Nilsson B. Hip fracture frequency in hospital. Acta Orthop Scand 1986;57:428–430.

    Article  PubMed  CAS  Google Scholar 

  17. Gallagher JC, Melton LJ, Riggs BL, Bergtrath E. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop 1980;150:163–167.

    PubMed  Google Scholar 

  18. Rizzo PF, Gould ES, Lyden JP, Asnis SE. Diagnosis of occult fractures about the hip: magnetic resonance imaging compared with bone-scanning. J Bone Joint Surg Am 1993;75: 395–401.

    PubMed  CAS  Google Scholar 

  19. Parker MJ, Myles JW, Anand JK, Drewatt R. Cost-benefit analysis of hip fracture treatment. J Bone Joint Surg Br 1992;74:261–264.

    PubMed  CAS  Google Scholar 

  20. Merli GJ. Update: deep venous thrombosis and pulmonary embolism prophylaxis in orthopaedic surgery. Med Clin North Am 1993;77:397–412.

    PubMed  CAS  Google Scholar 

  21. Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture: a prospective study in geriatric patients. Clin Orthop 1995;310: 150–159.

    PubMed  Google Scholar 

  22. Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Orthop Trauma 1988;1:298–305.

    Article  Google Scholar 

  23. White BL, Fischer WD, Lauren C. Rates of mortality for elderly patients after fracture of the hip in the 1980s. J Bone Joint Surg Am 1987;69:1335–1340.

    Google Scholar 

  24. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD. Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 1997;11:162–165.

    Article  PubMed  CAS  Google Scholar 

  25. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality: relation to age, treatment, preoperative illness, time of surgery and complications. Clin Orthop 1984;186:45–56.

    PubMed  Google Scholar 

  26. Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Orthop Trauma 1988;1:298–305.

    Article  Google Scholar 

  27. White BL, Fischer WD, Lauren C. Rates of mortality for elderly patients after fracture of the hip in the 1980s. J Bone Joint Surg Am 1987;69:1335–1340.

    Google Scholar 

  28. Zuckerman JD, Skovron ML, Koval KJ, Aharanoff GB, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 1995;77: 1551–1556.

    PubMed  CAS  Google Scholar 

  29. Frankel VH, Burstein AH, Lygre L, Brown RH. The telltale nail. J Bone Joint Surg Am 1971;53:1232.

    Google Scholar 

  30. Koval K, Sala DA, Kummer FJ, Zuckerman JD. Postoperative weightbearing after hip fracture. J Bone Joint Surg 1998;80(3)A:352–356.

    PubMed  CAS  Google Scholar 

  31. Koval K, Friend KD, Aharanoff GB, Zuckerman JD. Weightbearing after hip fracture: a prospective series of 596 geriatric hip fracture patients. J Orthop Trauma 1996; 10(8)526–530.

    Article  PubMed  CAS  Google Scholar 

  32. Bentley G. Treatment of non-displaced fractures of the femoral neck. Clin Orthop 1980;152:93–101.

    PubMed  Google Scholar 

  33. Barnes R, Brown JT, Garden RS, Nicoll EA. Subcapital fractures of the femur: a prospective review. J Bone Joint Surg Br 1976;58:2–24.

    PubMed  CAS  Google Scholar 

  34. Koval K, Sala DA, Kummer FJ, Zuckerman JD. Postoperative weightbearing after hip fracture. J Bone Joint Surg 1998;80(3)A:352–356.

    PubMed  CAS  Google Scholar 

  35. Calder SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ. Unipolar or bipolar prosthesis for displaced intracapsular hip fractures in octogenarians. J Bone Joint Surg Br 1996; 78:391–394.

    PubMed  CAS  Google Scholar 

  36. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br 1949;31:190–203.

    Google Scholar 

  37. Ramsey PL, Hamilton W. Changes in tibitalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 1976;58:356–357.

    PubMed  CAS  Google Scholar 

  38. Beauchamp CG, Clay NR, Thexton PW. Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg Br 1983;63:329–332.

    Google Scholar 

  39. Ali MS, McLaren AN, Routholamin E, O’Connor BT. Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma 1987;1:275–280.

    Article  PubMed  CAS  Google Scholar 

  40. Horak J, Nilsson BE. Epidemiology of fractures of the upper end of the humerus. Clin Orthop 1975;112:250–253.

    PubMed  Google Scholar 

  41. Neer CS. Displaced proximal humeral fractures. Part I. Classification and evaluation. J Bone Joint Surg Am 1970;52: 1077–1089.

    PubMed  Google Scholar 

  42. Koval K, Gallagher MA, Marsicano JG, Cuomo F, McShinway A, Zuckerman JD. Functional outcome after minimally displaced fracture of the proximal part of the humerus. J Bone Joint Surg Am 1997;79:203–207.

    PubMed  CAS  Google Scholar 

  43. Neer CS. Displaced proximal humerus fractures. Part II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970;52:1090–1103.

    PubMed  Google Scholar 

  44. Goldman R, Koval KJ, Guomo F, Gallagher MA, Zuckerman JD. Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. J Shoulder Elbow Surg 1995;4(2):81–86.

    Article  PubMed  CAS  Google Scholar 

  45. Alffram P, Bauer G. Epidemiology of fractures of the forearm. J Bone Joint Surg Am 1962;44:105–114.

    PubMed  Google Scholar 

  46. Fryckman G. Fractures of the distal radius including sequelae. Acta Orthop Scand Suppl 1967;180:1–153.

    Google Scholar 

  47. Colles A. On the fracture of the carpal extremity of the radius. Edinb Med Surg J 1814;10:182–186.

    Google Scholar 

  48. Villar RN, Marsh D, Righton N, Greatorex RA. Three years after Colles’ fracture: a prospective review. J Bone Joint Surg Br 1987;69:635–638.

    PubMed  CAS  Google Scholar 

  49. Cooney WP, Linscheid RL, Dobyns JH. External pin fixation for unstable Colle’s fractures. J Bone Joint Surg Am 1979;61: 840–845.

    PubMed  Google Scholar 

  50. Jensen GF, Christiansen C, Boesen J, et al. Epidemiology of postmenopausal spinal and long bone fractures. Clin Orthop 1982;166:75–81.

    PubMed  Google Scholar 

  51. Healey JH, Lane JM. Structural scoliosis in osteoporotic women. Clin Orthop 1985;95:216–223.

    Google Scholar 

  52. Bhardwaj S, Holland JF. Chemotherapy of metastatic cancer in bone. Clin Orthop 1982;169:34.

    Google Scholar 

  53. Harrington KD. Impending pathological fractures from metastatic malignancy: evaluation and management. CV Mosby St. Louis, MO: AAOS Instruct Course Lect 1986;35: 357–381.

    CAS  Google Scholar 

  54. Galasko CSB. Skeletal metastases. Clin Orthop 1986;210: 18–30.

    PubMed  Google Scholar 

  55. Bhardwaj S, Holland JF. Chemotherapy of metastatic cancer in bone. Clin Orthop 1982;169:34.

    Google Scholar 

  56. Bonarigo BC, Rubin P. Nonunion of pathological fracture after radiation therapy. Radiology 1967;88:889–898.

    PubMed  CAS  Google Scholar 

  57. Harrington KD, Sim FH, Enis JE, et al. Methylmethacrylate as an adjunct in internal fixation of pathological fractures. J Bone Joint Surg Am 1976;58:1047–1055.

    PubMed  CAS  Google Scholar 

  58. Harrington KD. Impending pathological fractures from metastatic malignancy: evaluation and management. AAOS Instruct Course Lect 1986;35:357–381.

    CAS  Google Scholar 

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Richmond, J.H., Koval, K.J., Zuckerman, J.D. (2001). Orthopedic Injuries. In: Rosenthal, R.A., Zenilman, M.E., Katlic, M.R. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3432-4_62

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  • DOI: https://doi.org/10.1007/978-1-4757-3432-4_62

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-3434-8

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