The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 25 June 2025 | Viewed by 4436

Special Issue Editor


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Guest Editor
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Interests: hip and pelvis; (revision) arthroplasty; hip fracture (acetabulum; periprosthetic); orthogeriatrics; fragility fracture care; co-management; patient journey; holistic care
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Special Issue Information

Dear Colleagues,

The “fragility fracture homunculus” (as published earlier, doi: 10.3390/medicina57060639) indicated a growing interest in fragility fracture research. However, more studies are desired to unite research focused on the “personality of the fracture” and “the personality of the (old) patient” to enhance patient-centered, holistic care.

With increasing age, the presence of osteoporosis, sarcopenia, gait disturbance with fall risk, and functional decline becomes more likely. This collection of issues frequently occurs in a recognizable pattern of varying severity, and issues are mostly associated with each other in older adults. As a result, affected adults are at risk of sustaining a fragility fracture. This so-called “Orthogeriatric Fracture Syndrome” needs to be discovered in more detail as health care professionals (following the ongoing demographic change) are increasingly exposed to it.

Accordingly, the aim and scope of this Special Issue is to raise awareness and enhance a collective understanding of the complexity and interactions (“Orthogeriatric Fracture Syndrome”) of older adults sustaining a fragility fracture. Thus, this Special Issue focuses on standards, controversies, and innovations in various perspectives of clinical medicine, offering the best possible recovery with regained independence and quality of life without suffering further fragility fractures to the fragility fracture patients.

We are soliciting clinical research according to the scope as above, with a focus on original articles. For the submission of reviews, reporting according to the PRISMA guidelines is required. To promote the idea of a continuum of care throughout the entire patient journey and to show an inclusive big picture, any submitted research article should report in the context of either (i) the “acute care perspective” of orthopedic and trauma surgeons (surgical management, techniques, outcome) and/or geriatricians (co-management), (ii) the “postacute care perspective” in rehabilitation centers (functioning and functionality), and/or (iii) the “outpatient care perspective” (primary care, fracture liaison services, preventive measures).

Prof. Dr. Johannes Dominik Bastian
Guest Editor

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Keywords

  • geriatric trauma
  • fragility fracture
  • orthogeriatric
  • co-management
  • assessment
  • integrated care
  • osteoporosis
  • sarcopenia
  • frailty
  • gait disturbance
  • fall
  • rehabilitation
  • prehabilitation
  • prevention
  • ehealth
  • digitalization

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Published Papers (4 papers)

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Research

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12 pages, 234 KiB  
Article
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 522
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  
Article
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
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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  
Article
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
Viewed by 870
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

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12 pages, 1540 KiB  
Review
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 474
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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