Īround 25–50% of people aged 85 and older are considered to be frail, meaning three or more of the following factors apply according to the definition of Fried et al.:įrailty describes a state of increased vulnerability to stressors, mostly due to a lack of resources. A geriatric patient is defined as a patient above the age of 80 or a patient with typical geriatric multimorbidity in combination with an age of > 70 years. Ĭomorbidities are high in patients with PFFs, with 50% of PFFs occurring in people with pre-existing nursing care needs. Within 1 year after a hip fracture, only 40–60% of elderly patients regain their pre-fracture level of mobility and ability to perform daily living activities. įor elderly patients, a PFF often represents a life-changing event, stripping patients of their already potentially impaired self-sustainability. While around 1.3 million hip fractures were reported globally in 1990, the number is estimated to range between 7.3 and 21.3 million by 2050. The majority of proximal femur fractures (PFFs) affects the elderly as more than three quarters of PFFs occur in patients over the age of 75 in Germany. This review aims to offer surgical guidelines for the treatment of PFFs in the elderly with a focus on pitfalls and challenges particularly relevant to frail patients. During the COVID-19 pandemic, prolonged time until surgery and thus an increased rate of complications took a toll on frail patients with PFFs. Postoperatively, the patients benefit from early mobilisation and early geriatric care. In bedridden patients, osteosynthesis might be an option to establish transferability from bed to chair and the restroom. Osteosynthesis is suitable for biologically young patients with non-dislocated fractures, whereas total hip arthroplasty and hemiarthroplasty are the main options for biologically old patients and displaced fractures. For femoral neck fractures, the Garden classification is used to differentiate between non-displaced and displaced fractures. The operative management of intertrochanteric and subtrochanteric fractures favours intramedullary nailing. Adequate pain medication, balanced fluid management, delirium prevention and the operative treatment choice based on comorbidities, individual demands and biological rather than chronological age, all deserve particular attention to improve patients’ outcomes. To deal with the exceptional needs of the elderly, the development of orthogeriatric centres to support orthogeriatric co-management is mandatory. Peri-operative management must be handled attentively to avoid complications and decrease mortality rates. This is a result of the demographic change that is expressed by the increasing proportion of elderly people in society. Generally, a thigh bone fracture will take 3-6 months to heal completely.Ī thorough rehabilitation program should be undertaken to regain full movement, strength, and balance.As one of the leading causes of elderly patients’ hospitalisation, proximal femur fractures (PFFs) will present an increasing socioeconomic problem in the near future. Once it has healed, the metalwork may or may not be removed. Or use plates and screws to bring the fractured bones together. Therefore, depending on the location of the fracture your surgeon will use large nails (intramedullary nails) which are inserted through the bone. As a result, it takes a long time to heal. Surgical fixation is used most frequently.īlood flow to the femur is poor. However, in adults and adolescents, casting is not usually recommended unless the leg is also placed in traction.ĭue to the length of stay in hospital stay, this form of treatment is rarely used. The type of treatment needed depends on the extent and location of the fracture and your age.įor example, in young children immobilizing the leg in a cast may be sufficient. As a result, the risk of infection is higher. An open fracture is one where the bone has punctured the skin. If you break your femur then you are very likely to have other injuries or complications as well. The elderly, especially those affected by Osteoporosis are more susceptible to femur fractures. For this reason, broken femurs are most frequently seen in road traffic accidents and falls. It takes a lot of force to break the femur as it is a very strong, thick bone. Traumatic femur fractures occur from one specific force.
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