Journal of Clinical Medicine

Research

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14 pages, 587 KiB

Open AccessArticle

Which Patients in the FLS Should Be Prioritised for a DXA Scan Within 12 Weeks?

by Hege Nysted, Oda Horpestad and Ane Djuv

J. Clin. Med. 2025, 14(16), 5619; https://doi.org/10.3390/jcm14165619 - 8 Aug 2025

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Abstract

At Stavanger University Hospital (SUH), patients aged 50 years and above with a fracture after a fall are included in our Fracture Liaison Service (FLS) at the orthopaedic department, due to their high imminent fracture risk. The FLS at SUH keeps a quality [...] Read more.

At Stavanger University Hospital (SUH), patients aged 50 years and above with a fracture after a fall are included in our Fracture Liaison Service (FLS) at the orthopaedic department, due to their high imminent fracture risk. The FLS at SUH keeps a quality registry, including index fractures, fall from standing/walking, preventive factors, Dual Absorptiometry X-ray (DXA) results and treatment status, in addition to risk factors such as chronic diseases. As in many other hospitals and countries, the capacity of the DXA scanner at SUH does not meet the needs of the ageing population. As such, FLS patients should be prioritised for DXA scanning according to their need for anti-osteoporotic treatment. The aims of this study were (1) to identify whether any risk factors are more strongly associated with osteoporosis than others, and (2) to use this information as a tool to prioritise patients for which the decision to initiate anti-osteoporotic treatment should be assessed by a DXA scan. Method: We used software from CheckWare to keep a structured health record, submitting journal text to the health record and data to our fracture quality registry from 1 June 2022 to 31 December 2024. The fracture coverage of the registry, as part of the medical record, was 100%. Both men and women aged over 50 years with fragility-related fractures were included in the analysis, with index fracture having been reported within 24 months prior to FLS assessment. Exclusion criteria: short life expectancy (<3 years), already started on anti-osteoporotic treatment, living in nursing home, age >97 years, or multi-trauma patients. Statistics were calculated using SPSS and logistic regression. The results are presented as odds ratio (OR) and 95% confidence interval (95% CI). Significant differences were considered at a p-value of <0.05. Results: A total of 6974 patients were included, 81% of which were female. After the DXA scan, 5307 of the patients were started on anti-osteoporotic treatment (76%). Patients aged 50–70 years were the largest group. Female patients or those aged 80 years or older had an increased odds ratio (OR) of starting treatment after a fracture. The index fractures included in the logistic regression analysis and were most likely to initiate anti-osteoporotic treatment in the FLS, were vertebral fracture (p < 0.000, OR 3.1, 95% CI: 2.4–4.0), hip fracture (p < 0.000, OR 2.60, 95% CI: 1.9–3.5), costa fracture (p-value = 0.028, OR:1.3, 95% CI:1.0–1.5), pelvic fracture (p-value < 0.000, OR 3.1, 95% CI: 1.8–5.1). Patients with lack of sufficient vitamin D had increased odds with OR of 1.7 (p-value < 0.00, 95% CI: 1.3–2.2) for having osteoporosis compared to the other FLS patients. Fall from standing, walking or sitting increased the odds for osteoporosis treatment (p-value < 0.000, OR 2.8, 95% CI: 2.3–3.3). Conclusions: The listed risk factors for needing treatment were high for most fractures, especially vertebral, hip, and pelvic fractures. Patients aged 80+ years and with a fracture from standing/walking could also start treatment directly, without waiting for a DXA scan. Thus, these patients should be shifted rapidly to FLS and started on treatment without delay. In this way, DXA scanning can be prioritised for patients for whom supporting information is needed regarding the decision to initiate anti-osteoporotic treatment, such as those with proximal humerus, wrist, or ankle fractures. Time to DXA scan could be shortened for these patients and 12 weeks may be achievable. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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14 pages, 759 KiB

Open AccessArticle

Vitamin D Deficiency and Exocrine Pancreatic Insufficiency: An Analysis Carried Out in Orthogeriatric Patients (VIDEP.org)

by Pavol Mikula, Matthias Unseld and Hans Jürgen Heppner

J. Clin. Med. 2025, 14(15), 5558; https://doi.org/10.3390/jcm14155558 - 7 Aug 2025

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Abstract

Introduction: Vitamin D deficiency, a reversible cause of osteoporosis, is increasingly prevalent, showing varying degrees of severity that are notably pronounced among the growing population of multimorbid elderly patients. Given that the aging pancreas undergoes senescent processes leading to impaired function—which negatively impacts [...] Read more.

Introduction: Vitamin D deficiency, a reversible cause of osteoporosis, is increasingly prevalent, showing varying degrees of severity that are notably pronounced among the growing population of multimorbid elderly patients. Given that the aging pancreas undergoes senescent processes leading to impaired function—which negatively impacts enteral vitamin D absorption and, consequently, elderly bone metabolism—a specific diagnostic and treatment approach is crucial. Our study aimed to determine the prevalence of vitamin D deficiency and exocrine pancreatic insufficiency (EPI) in orthogeriatric patients. We also evaluated differences in vitamin D deficiency severity between patients with normal and impaired pancreatic function. Furthermore, a short-term monitoring of vitamin D level increases after 12 days of substitution therapy in both groups aimed to inform osteoanabolic therapy for specific high-fracture-risk patients, assessing the influence of pancreatic function on substitution efficacy. Methods: We conducted a retrospective, monocentric cohort study, evaluating data from all patients hospitalized with manifest osteoporosis in an orthogeriatric department during a six-month spring/summer period. Demographic data, relevant comorbidities, the type of fracture, the amount of faecal elastase 1 (CALEX^® Cap Bühlmann), and the serum levels of 25-hydroxyvitamin D (25(OH)D) were assessed. Results: We found a high prevalence (70.6%) of vitamin D deficiency (25(OH)D < 30 µg/L) among all orthogeriatric patients. Of these, 16% met the criteria for mild to severe EPI. The group with normal exocrine pancreatic function showed a higher average vitamin D value, and their increase in vitamin D levels following short-term substitution was up to 100% greater compared to the group with impaired pancreatic function. Notably, 69% of women and 20% of men met the therapeutic threshold for specific osteoanabolic osteoporosis therapy, even without a T-score. Conclusions: Our findings reveal a very high prevalence of vitamin D deficiency and a high prevalence of EPI in orthogeriatric patients. Those with impaired exocrine pancreatic function exhibit lower baseline vitamin D levels and a diminished capacity for vitamin D absorption during short-term monitoring. These results have significant clinical implications for osteoporotic therapy, given that a substantial proportion of patients, particularly women, meet the criteria for specific osteoanabolic treatment. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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12 pages, 441 KiB

Open AccessArticle

Diagnostic Value of Point-of-Care Ultrasound for Sarcopenia in Geriatric Patients Hospitalized for Hip Fracture

by Laure Mondo, Chloé Louis, Hinda Saboul, Laetitia Beernaert and Sandra De Breucker

J. Clin. Med. 2025, 14(15), 5424; https://doi.org/10.3390/jcm14155424 - 1 Aug 2025

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Abstract

Introduction: Sarcopenia is a systemic condition linked to increased morbidity and mortality in older adults. Point-of-Care Ultrasound (POCUS) offers a rapid, bedside method to assess muscle mass. This study evaluates the diagnostic accuracy of POCUS compared to Dual-energy X-ray Absorptiometry (DXA), the [...] Read more.

Introduction: Sarcopenia is a systemic condition linked to increased morbidity and mortality in older adults. Point-of-Care Ultrasound (POCUS) offers a rapid, bedside method to assess muscle mass. This study evaluates the diagnostic accuracy of POCUS compared to Dual-energy X-ray Absorptiometry (DXA), the gold standard method, and explores its prognostic value in old patients undergoing surgery for hip fractures. Patients and Methods: In this prospective, single-center study, 126 patients aged ≥ 70 years and hospitalized with hip fractures were included. Sarcopenia was defined according to the revised 2018 EWGSOP2 criteria. Muscle mass was assessed by the Appendicular Skeletal Muscle Mass Index (ASMI) using DXA and by the thickness of the rectus femoris (RF) muscle using POCUS. Results: Of the 126 included patients, 52 had both DXA and POCUS assessments, and 43% of them met the diagnostic criteria for sarcopenia or severe sarcopenia. RF muscle thickness measured by POCUS was significantly associated with ASMI (R² = 0.30; p < 0.001). POCUS showed a fair diagnostic accuracy in women (AUC 0.652) and an excellent accuracy in men (AUC 0.905). Optimal diagnostic thresholds according to Youden’s index were 5.7 mm for women and 9.3 mm for men. Neither RF thickness, ASMI, nor sarcopenia status predicted mortality or major postoperative complications. Conclusions: POCUS is a promising, accessible tool for diagnosing sarcopenia in old adults with hip fractures. Nonetheless, its prognostic utility remains uncertain and should be further evaluated in long-term studies. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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17 pages, 631 KiB

Open AccessArticle

Clinical and Patient-Focused Outcomes After Percutaneous Screw Fixation of Pelvic Ring Fractures in Older Adults

by Anna H. M. Mennen, Jan Boon, Jens A. Halm, Rolf W. Peters, Frank W. Bloemers and Daphne Van Embden

J. Clin. Med. 2025, 14(11), 3919; https://doi.org/10.3390/jcm14113919 - 3 Jun 2025

Viewed by 761

Abstract

Background: Percutaneous screw fixation has increasingly been used for pelvic ring fracture fixation. In older adult patients, especially in patients with a fragility fracture of the pelvis (FFP), minimally invasive techniques followed by early ambulation have been promoted in order to regain pre-injury [...] Read more.

Background: Percutaneous screw fixation has increasingly been used for pelvic ring fracture fixation. In older adult patients, especially in patients with a fragility fracture of the pelvis (FFP), minimally invasive techniques followed by early ambulation have been promoted in order to regain pre-injury levels of mobility and independence. The purpose of this study was to evaluate patient-centered outcomes, including post-operative pain relief, functional performance, and satisfaction, in older adults with pelvic ring fractures treated with percutaneous screw fixation and to assess injury characteristics, complications, and return-to-home rates. Methods: In this retrospective cohort study, patients 50 years and older who had their pelvic fracture treated in the Amsterdam UMC location AMC between January 2019 and December 2022 were identified. After a minimum follow-up period of 6 months, a questionnaire was conducted by phone to evaluate the pain, current living situation, and mobility of the patients. Results: A total of 51 patients were included in this study with a median age of 74 years (IQR 62–82), and the vast majority were female (n = 40, 78%). Over half of the pelvic fractures were caused by low-energy trauma (n = 29, 57%). Unilateral or bilateral sacral fractures with unilateral anterior ring fractures were the most common fracture pattern. The interoperative complication rate was 4%, and the in-hospital complication rate was 23%. Forty-five patients were reached to complete the questionnaire. Forty patients (91%) returned to an acceptable level of mobility after treatment, and almost all (n = 44, 98%) were pleased with the results of the surgery. Conclusions: Percutaneous screw fixation of pelvic fractures in older adult patients is a safe and effective operating technique. Most patients preserve their pre-morbid functionality and are able to return to their previous place of residence after admission. Furthermore, patients are almost unanimously very pleased with the results of the surgery despite some residual pain complaints. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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12 pages, 234 KiB

Open AccessArticle

In-Hospital Proximal Femoral Fracture Mortality and Anesthesia: Do the First Postoperative 72 h Matter?

by Raphael Lotan, Chamad Moayad, Mojahed Sakhnini, Nugzar Rijini, Adam Lee Goldstein and Oded Hershkovich

J. Clin. Med. 2025, 14(6), 1885; https://doi.org/10.3390/jcm14061885 - 11 Mar 2025

Viewed by 813

Abstract

Background/Objectives: Proximal femoral fractures (PFFs) are a common worldwide ailment, causing high morbidity and mortality among the elderly, with one-year mortality estimated at 15–30%. This study aimed to identify factors influencing in-hospital patient survival after proximal femoral fracture surgery. Methods: A [...] Read more.

Background/Objectives: Proximal femoral fractures (PFFs) are a common worldwide ailment, causing high morbidity and mortality among the elderly, with one-year mortality estimated at 15–30%. This study aimed to identify factors influencing in-hospital patient survival after proximal femoral fracture surgery. Methods: A retrospective cohort study of patients over 65 admitted to an orthopedic surgery department due to a PFF over five years was carried out. Medical records, surgery reports, anesthesia and post-anesthesia care unit sheets, and laboratory archives were reviewed. Results: The study group consisted of 48 patients who died during the first postoperative week, while the control group consisted of 69 patients who were discharged for rehabilitation after a week. The study group was older, less active, and had higher rates of comorbidities. Anesthetic factors, such as the type of anesthesia and admixture of drugs, did not have a significant association with mortality. However, a binary logistic regression showed that age (OR = 1.15, p < 0.001), intraoperative lactate levels (OR = 5.86, p < 0.001), and post-anesthesia care unit (PACU) overnight stays (OR = 17.54, p < 0.001) were significantly associated with early mortality. Conclusions: The study highlights the challenge of identifying PFF patients at risk of early mortality and the need to better understand the decision-making algorithm to create a reliable scale that can predict mortality and adjust treatment. In our study, solid mortality parameters were age and intraoperative lactate levels. The most significant parameter was PACU overnight stay, which represents the anesthesiologist’s soft-skill-based decision that is challenging to scale and reproduce. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

13 pages, 564 KiB

Open AccessArticle

Discriminative Ability and Associations of Sarcopenia Using Point-of-Care Ultrasound with Functional, Mobility and Frailty Status in Older Inpatients

by Rahel Zehnder, Martin Schimmel, Lisa Meyer, Miriam Kömeda, Andreas Limacher and Anna K. Eggimann

J. Clin. Med. 2025, 14(5), 1603; https://doi.org/10.3390/jcm14051603 - 27 Feb 2025

Viewed by 713

Abstract

Background/Objectives: We aimed to assess the discriminative ability of point-of-care ultrasound (POCUS) of the rectus femoris (RF) to detect sarcopenia and to examine associations of these sarcopenia measures with functional, mobility, and frailty status among older inpatients. Methods: Data were analysed from 161 [...] Read more.

Background/Objectives: We aimed to assess the discriminative ability of point-of-care ultrasound (POCUS) of the rectus femoris (RF) to detect sarcopenia and to examine associations of these sarcopenia measures with functional, mobility, and frailty status among older inpatients. Methods: Data were analysed from 161 patients aged 70 years and older consecutively admitted to a tertiary geriatric rehabilitation hospital between October and December 2023. The RF thickness and cross-sectional area (CSA) were measured using POCUS applying validated cut-offs. Ability of muscle ultrasound to detect sarcopenia based on bioelectrical impedance analysis (BIA) as the reference standard was calculated using receiver operating characteristics analyses (ROC). Second, associations of sarcopenia measures based on either the ultrasonographic RF thickness, or the RF cross-sectional area with functional, frailty, and mobility status were analysed using multivariable logistic regression analyses. Results: Mean age was 84.0 years (standard deviation (SD) 6.1 years) and 64.4% were women. Overall, 31 (19.3%) patients had sarcopenia based on low grip strength and low muscle mass using the BIA. The mean ultrasonographic RF thickness and CSA were 13 mm (SD 4.1) and 4.3 cm² (SD 1.7), respectively. Correlation coefficients of the RF thickness with BIA-muscle mass were r = 0.52 in males, versus r = 0.40 in females. Both sarcopenia measures using the RF thickness and CSA were positively associated with functional (adjusted odds ratio (OR) 9.3 (95% CI 3.7–23.4) and 9.2 (3.6–23.7)) and frailty status (OR 4.0 (95% CI 2.1–12.1) and 4.3 (1.8–10.4)). None of the sarcopenia measures were significantly associated with mobility status. Conclusions: Rectus femoris thickness and CSA measured by POCUS showed a fair discriminative ability to detect sarcopenia based on BIA, suggesting that BIA and POCUS measure different aspects of muscle health. A strong association between sarcopenia based on POCUS and functional and frailty status suggest the potential utility of POCUS in the diagnostic evaluation of sarcopenia among older hospitalised patients; however, further study is required. Research should focus on establishing valid sex-specific cut-offs for grip strength and muscle mass, with the ultimate goal of developing a low-cost, bedside, and sensitive diagnostic toolkit for detecting sarcopenia in older patients. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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11 pages, 8069 KiB

Open AccessArticle

Clinical and Functional Outcomes of Peri-Implant Fractures Associated with Short Proximal Femur Nails: Prevention Strategies and Key Insights

by Ignacio Aguado-Maestro, Sergio Valle-López, Clarisa Simón-Pérez, Emilio-Javier Frutos-Reoyo, Ignacio García-Cepeda, Inés de Blas-Sanz, Ana-Elena Sanz-Peñas, Jesús Diez-Rodríguez, Juan-Pedro Mencía-González and Carlos Sanz-Posadas

J. Clin. Med. 2025, 14(1), 261; https://doi.org/10.3390/jcm14010261 - 5 Jan 2025

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Abstract

Background: Hip fractures are prevalent among the elderly and impose a significant burden on healthcare systems due to the associated high morbidity and costs. The increasing use of intramedullary nails for hip fracture fixation has inadvertently introduced risks; these implants can alter [...] Read more.

Background: Hip fractures are prevalent among the elderly and impose a significant burden on healthcare systems due to the associated high morbidity and costs. The increasing use of intramedullary nails for hip fracture fixation has inadvertently introduced risks; these implants can alter bone elasticity and create stress concentrations, leading to peri-implant fractures. The aim of this study is to investigate the outcomes of peri-implant hip fractures, evaluate the potential causes of such fractures, determine the type of treatment provided, assess the outcomes of said treatments, and establish possible improvement strategies. Methods: We conducted a retrospective observational study on 33 patients with peri-implant hip fractures (PIFs) who underwent surgical management at Río Hortega University Hospital from 2010 to 2022. The collected data included demographics, initial fracture characteristics, the peri-implant fracture classification, implant details, surgical outcomes, functional scores, and complications. Functional capacity was evaluated using the Parker Mobility Score (PMS). Results: The cohort (91% female, mean age 87.6 years) included 34 peri-implant fractures. The mean time from the initial fracture to the PIF was 47.2 months (nine patients developed PIFs within 2 months). Most fractures (76%) were managed with implant removal and the insertion of a long intramedullary nail, with cement augmentation in 31% of cases. The mean surgical time was 102 min, and the average hospital stay was 9.6 days. Postoperative complications occurred in 27%, with a perioperative mortality rate of 9%. Functional capacity showed a significant decline, with an average PMS loss of 4.16 points. Mortality at one year post-PIF was 36%, rising to 83% at five years. Radiographic consolidation was observed in 72% of cases at an average of 6.04 months, though 24% of patients died before consolidation. Statistically significant correlations were found for PMS pre-index fracture (PMS1: r = 0.354, p < 0.05), pre-PIF (PMS2: r = 0.647, p < 0.001), and post-PIF (PMS3: r = 0.604, p < 0.001). Conclusions: Peri-implant hip fractures present complex challenges due to their surgical difficulty and impact on patient mobility and survival. Successful management requires individualized treatment based on fracture type, implant positioning, and patient factors. These findings underscore the need for preventive measures, particularly in implant choice and techniques like overlapping and interlocking constructs, to minimize the secondary fracture risk. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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Review

Jump to: Research, Other

12 pages, 1540 KiB

Open AccessReview

Controversies in the Treatment Strategies of Intertrochanteric Fractures: A Scoping Review and Discussion of a Literature-Based Algorithm

by Tilman Graulich, Mohamed Omar, Stephan Sehmisch and Emmanouil Liodakis

J. Clin. Med. 2025, 14(7), 2200; https://doi.org/10.3390/jcm14072200 - 24 Mar 2025

Viewed by 2013

Abstract

Intertrochanteric fractures become more and more relevant in an aging population. Despite significant progress in the treatment of these fractures, some technical details, concerning the surgical procedure, are still a matter of strong debate. In this review of the literature, we have included [...] Read more.

Intertrochanteric fractures become more and more relevant in an aging population. Despite significant progress in the treatment of these fractures, some technical details, concerning the surgical procedure, are still a matter of strong debate. In this review of the literature, we have included the best evidence available from the last decade in an effort to shed light on some of the most controversial subjects related to intertrochanteric fractures: Treatment in the case of polytrauma or monotrauma? Reconstruction or arthroplasty? Open or closed reduction? Reconstruction with or without additional cables and plates? Cephalomedullary nail or dynamic hip screw (DHS)? Long cephalomedullary nail or short cephalomedullary nail? The results of this scoping review are controversial. By introducing a new therapeutic algorithm, we do not intend to present a new finished guideline but rather arouse a controversial debate about a relevant aspect in geriatric traumatology. These conflicting results are an indication that larger and more well-conducted, high-quality trials are needed in order to gain more secure answers. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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Other

Jump to: Research, Review

17 pages, 637 KiB

Open AccessSystematic Review

Time Is Bone: Missed Opportunities for Secondary Prevention After a Hip Fracture

by Ioannis I. Daskalakis, Johannes D. Bastian and Theodoros H. Tosounidis

J. Clin. Med. 2025, 14(16), 5816; https://doi.org/10.3390/jcm14165816 - 17 Aug 2025

Viewed by 348

Abstract

Background/Objectives: Early evaluation and treatment of osteoporosis following a hip fracture is of paramount importance for secondary fracture prevention. Nevertheless, the extent to which osteoporosis management is documented in studies reporting on operatively treated hip fractures in elderly patients is unclear. This study [...] Read more.

Background/Objectives: Early evaluation and treatment of osteoporosis following a hip fracture is of paramount importance for secondary fracture prevention. Nevertheless, the extent to which osteoporosis management is documented in studies reporting on operatively treated hip fractures in elderly patients is unclear. This study is the first systematic review aiming to investigate and summarize the reporting of osteoporosis management in studies with operatively treated hip fractures in elderly patients. Methods: This systematic review was conducted in compliance with PRISMA guidelines. A comprehensive search within the last decade of PubMed, Embase, Cochrane Library, Web of Science, and Ovid was performed. Studies reporting on operatively treated hip fractures in patients older than 65 years of age were included. Two reviewers independently screened the studies and performed data extraction. A subsequent descriptive synthesis was performed. Results: Eighty-six (86) articles were included in this study. Osteoporosis management was reported in only twelve (12) studies. Only six (6) of them were conducted in institutions with established orthogeriatric care. Conclusions: Osteoporosis management is underreported in studies involving operatively treated hip fracture patients. This reflects a significant gap in the overall reporting of secondary fracture prevention actions. Consequently, we advocate for both (a) clinical vigilance for adherence to best practice related to osteoporosis management after the first hip fracture and reporting of the results and (b) the research focusing on the outcomes of secondary fracture prevention efforts. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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18 pages, 641 KiB

Open AccessSystematic Review

Malnutrition in Older Hip Fracture Patients: Prevalence, Pathophysiology, Clinical Outcomes, and Treatment—A Systematic Review

by Geert Meermans and Jeroen C. van Egmond

J. Clin. Med. 2025, 14(16), 5662; https://doi.org/10.3390/jcm14165662 - 11 Aug 2025

Viewed by 530

Abstract

Background: Malnutrition is highly prevalent among older patients with hip fractures and significantly impacts recovery and survival. This narrative review synthesizes current evidence on the prevalence, pathophysiology, and clinical consequences of malnutrition in hip fracture patients, along with diagnostic tools and nutritional [...] Read more.

Background: Malnutrition is highly prevalent among older patients with hip fractures and significantly impacts recovery and survival. This narrative review synthesizes current evidence on the prevalence, pathophysiology, and clinical consequences of malnutrition in hip fracture patients, along with diagnostic tools and nutritional interventions. Methods: A literature search of studies from 2000 to 2025 identified consistent associations between malnutrition—defined using tools such as the Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index (GNRI), and serum albumin levels—and increased risks of postoperative complications, prolonged hospital stays, functional decline, and mortality. Pathophysiological mechanisms include sarcopenia, systemic inflammation, and impaired bone metabolism. Results: Notably, malnutrition is associated with fracture type, with low lean body mass and poor nutritional status correlating with intracapsular femoral neck fractures. Conclusions: Interventional studies demonstrate that oral nutritional supplementation (ONS) reduces complications and improves biochemical parameters but shows mixed effects on long-term mortality and function. The findings support routine nutritional screening and early intervention in older hip fracture patients to improve outcomes and reduce the healthcare burden. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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11 pages, 2706 KiB

Open AccessTechnical Note

The RESCUE Technique: A Mnemonic Acronym to Enhance Outcomes in Nail Fixation of Extracapsular Hip Fractures

by Anastasios P. Nikolaides, Julius Bryan Abesamis, Ahmed Hamed, Samer Sarofeen, Niraj Vetharajan, Rajpreet Sahemey, Omer Salar and Panagiotis Konstantinou

J. Clin. Med. 2025, 14(15), 5419; https://doi.org/10.3390/jcm14155419 - 1 Aug 2025

Viewed by 357

Abstract

Intertrochanteric fractures in the elderly present complex challenges due to poor bone quality and comorbidities. Cephalomedullary (CM) nails offer biomechanical advantages that support early mobilization, yet complications such as cutout, implant failure, and malalignment persist. This review examines the effectiveness of CM nail [...] Read more.

Intertrochanteric fractures in the elderly present complex challenges due to poor bone quality and comorbidities. Cephalomedullary (CM) nails offer biomechanical advantages that support early mobilization, yet complications such as cutout, implant failure, and malalignment persist. This review examines the effectiveness of CM nail fixation in geriatric extracapsular hip fractures and introduces the RESCUE technique—a structured, mnemonic-based approach aimed at improving surgical outcomes and reducing common complications. RESCUE stands for Reduce, Entry point, Screw, Compress, Unleash traction, and Enhance full-weight bearing. This six-step framework addresses the critical elements of fixation, including precise reduction, optimal entry point selection, central screw placement, controlled fracture compression, cautious traction management, and early mobilization. Case illustrations of frequent failure patterns underscore the practical application of the RESCUE technique. By following this systematic approach, surgeons can enhance construct stability, minimize failure risk, and promote functional recovery in elderly patients. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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23 pages, 4725 KiB

Open AccessTutorial

Fragility Fractures of the Pelvis—Current Understanding and Open Questions

by Amber Gordon, Michela Saracco, Peter V. Giannoudis and Nikolaos K. Kanakaris

J. Clin. Med. 2025, 14(14), 5122; https://doi.org/10.3390/jcm14145122 - 18 Jul 2025

Viewed by 1191

Abstract

Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is [...] Read more.

Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon’s experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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17 pages, 2631 KiB

Open AccessSystematic Review

Are There Benefits of Total Hip Arthroplasty with Dual-Mobility Cups Compared to Bipolar Hemiarthroplasty for Femoral Neck Fractures in the Geriatric Population? A Systematic Review and Meta-Analysis of Comparative Studies

by Dimitrios Grammatikopoulos, Vasileios F. Pegios, Stavros Tsotsolis, Eustathios Kenanidis and Eleftherios Tsiridis

J. Clin. Med. 2025, 14(14), 5076; https://doi.org/10.3390/jcm14145076 - 17 Jul 2025

Viewed by 453

Abstract

Background/Objectives: The optimal treatment for femoral neck fractures (FNFs) in the elderly remains unclear. Internal fixation, bipolar hip hemiarthroplasty (BH), standard total hip arthroplasty (THA), or dual mobility (DM-THA) cups have been employed, each presenting various advantages and disadvantages. This systematic review [...] Read more.

Background/Objectives: The optimal treatment for femoral neck fractures (FNFs) in the elderly remains unclear. Internal fixation, bipolar hip hemiarthroplasty (BH), standard total hip arthroplasty (THA), or dual mobility (DM-THA) cups have been employed, each presenting various advantages and disadvantages. This systematic review and meta-analysis evaluated comparative studies of BH and DM-THA in FNFs among the elderly, aiming to ascertain differences in outcomes, including functional recovery, patient-reported outcome measures, implant survival, complications, and mortality rates. Methods: This meta-analysis followed PRISMA 2020 guidelines with a pre-registered PROSPERO protocol (CRD420251065762). A comprehensive search of electronic databases and grey literature included only comparative studies of BH and DM-THA in patients over 65 years with FNFs. Results: Sixteen studies were eligible, comprising four randomised controlled trials and twelve retrospective comparative studies involving 11,460 patients (10,036 BH; 1424 DM-THA). Patients with DM-THA exhibited a higher postoperative Harris Hip Score (4.55, p < 0.0001), alongside a lower dislocation risk ([OR] 2.77, p < 0.0001), a reduced revision rate ([OR] 2.36, p < 0.0001), and decreased mortality ([OR] 1.94, p < 0.0001). The operative time was somewhat longer in the DM-THA group, by 12.71 min, and blood loss was greater by 121 mL, indicating significant heterogeneity across the studies. Conclusions: DM-THA for FNFs in elderly patients results in improved functional recovery and lower dislocation, reoperation, and mortality risk. However, longer operative times and increased blood loss remain significant considerations. Further, well-designed comparative studies are required to evaluate overall cost-effectiveness and define the optimal age threshold, beyond which the limitations of DM-THA may outweigh its benefits. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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Open AccessSystematic Review

Rehabilitation Protocols for Surgically Treated Acetabular Fractures in Older Adults: Current Practices and Outcomes

by Silviya Ivanova, Ondrej Prochazka, Peter V. Giannoudis, Theodoros Tosounidis, Moritz Tannast and Johannes D. Bastian

J. Clin. Med. 2025, 14(14), 4912; https://doi.org/10.3390/jcm14144912 - 10 Jul 2025

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Abstract

Background/Objectives: Acetabular fractures in older adults pose significant challenges due to bone fragility, complex fracture patterns, and increased comorbidities. Surgical management, including isolated open reduction and internal fixation (ORIF) and ORIF combined with acute total hip arthroplasty (THA) (combined hip procedure—CHP), have [...] Read more.

Background/Objectives: Acetabular fractures in older adults pose significant challenges due to bone fragility, complex fracture patterns, and increased comorbidities. Surgical management, including isolated open reduction and internal fixation (ORIF) and ORIF combined with acute total hip arthroplasty (THA) (combined hip procedure—CHP), have advanced considerably. Nevertheless, optimal postoperative rehabilitation and particularly weight-bearing (WB) recommendations remain controversial and inconsistent. This review aims to assess rehabilitation protocols, focusing on WB strategies following the surgical treatment of acetabular fractures in older adults. It also examines differences in WB restrictions by surgical technique (ORIF vs. CHP) and their impact on recovery, complications, reoperations, and mortality. Methods: A systematic review of PubMed, Embase, and the Cochrane Library (2006–2024) included studies involving patients aged ≥65 years treated surgically for displaced acetabular fractures. Data included WB protocols (full, partial, toe-touch), length of stay (LOS), healing, functional outcomes (mobility, Harris and Oxford Hip Scores), complications, reoperations, delayed THA, compliance, readmission, and mortality. Due to heterogeneity, findings were narratively synthesized. Risk of bias was assessed using ROBINS-I and RoB2. Results: Twenty studies involving 929 patients (530 isolated ORIF, 399 CHP) were analyzed. The overall mean follow-up was 3.5 years (range: 1–5.25 years). Postoperative WB protocols were reported in 19 studies (95%). Immediate full WB was permitted in 0% of isolated ORIF studies (0/13), with partial WB recommended by 62% (8/13) for durations typically between 6 and 12 weeks. On the other hand, immediate full WB was allowed in 53% (9/17) of CHP studies. Functional outcomes were moderate following isolated ORIF (mean HHS: 63–82 points), with delayed THA conversion rates ranging from 16.5% to 45%. CHP demonstrated superior functional outcomes (mean HHS: 70–92 points), earlier independent ambulation, and higher patient satisfaction (74–90%), yet increased orthopedic complications, including dislocations (8–11%) and implant loosening (up to 18%). LOS varied from 12 to 21 days (mean 16 days) for isolated ORIF and from 8 to 25 days (mean 17 days) for CHP. Readmission within 30 days was not explicitly reported in any study. Mortality at 1 year varied significantly (ORIF: 0–25%; CHP: 0–14%), increasing markedly at long-term follow-up (up to 42% ORIF, up to 70% CHP at five years). Compliance with WB restrictions was monitored in only two studies (11%). Conclusions: Postoperative rehabilitation after acetabular fracture surgery in older adults remains inconsistent and lacks standardization. Combining ORIF with acute THA may enable earlier weight-bearing and improved short-term function but carries risks such as dislocation and implant loosening. In contrast, isolated ORIF avoids these implant-related complications but often requires prolonged weight-bearing restrictions. Robust evidence is still missing. Future trials are essential to establish standardized protocols that balance mechanical protection and functional recovery. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

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