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Geriatric Fracture Care: Bridging Orthopedics and Gerontology

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Dr. Tom Knauf

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Department of Orthopaedics and Trauma Surgery, Helios Kliniken Kassel, 34121 Kassel, Germany
Interests: geriatric trauma; proximal femur fractures; hip fracture

Prof. Dr. Daphne Asimenia Eschbach

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Guest Editor

Department of Orthopaedics and Trauma Surgery, Helios Kliniken Kassel, 34121 Kassel, Germany
Interests: geriatric trauma; fractures; orthopaedics

Special Issue Information

Dear Colleagues,

The recent demographic changes are responsible for the rising number of geriatric trauma patients. Therefore, geriatric fracture are increasingly becoming the focus of medical and healthcare policy. These fractures are not only associated with increased morbidity, but also a significantly increased patient mortality rate. These injuries are often a turning point in the lives of those affected and represent a major challenge both medically and organizationally. Frailty and the associated reduced physiological reserve have decisive influence on prognosis. It increases the risk of complications, prolongs rehabilitation phases and makes it more difficult to return to independence.

Orthopaedic treatment alone is often not sufficient to meet the needs of this demanding group of patients; an interdisciplinary approach is required that integrates both surgical expertise and geriatric specialist knowledge. Therfore, an orthogeriatric treatment is necessary to improve the patients’ outcome.

This Special Issue “Geriatric Fracture Care: Bridging Orthopedics and Gerontology” is dedicated to precisely address this interface. The aim is to present current developments, innovative care models and evidence-based approaches that enable patient-centered, age-appropriate treatment. The focus is on topics such as improvement of operative care, perioperative risk minimization, rehabilitation and interdisciplinary collaboration in specialist teams.

We invite readers to join us in taking a look at the challenges and opportunities of age-appropriate fracture care with the aim of building bridges between surgical technology and geriatric medicine.

Dr. Tom Knauf
Prof. Dr. Daphne Asimenia Eschbach
Guest Editors

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13 pages, 728 KB

Open AccessArticle

Threshold Effect of Time to Admission on Long-Term Mortality in Geriatric Hip Fractures: A 24-H Critical Window Identified

by Bin-Fei Zhang and Ming-Xu Wang

J. Clin. Med. 2026, 15(2), 752; https://doi.org/10.3390/jcm15020752 - 16 Jan 2026

Viewed by 539

Abstract

Objective: This study aimed to investigate the association between time to admission (TTA) and long-term mortality in patients with hip fractures, enabling surgeons to assess individual risks and prevent adverse outcomes. Methods: Demographic and clinical data of patients with hip fractures were obtained from medical records in our hospital. Patients aged 65 years or older were included. TTA was defined as the time from injury to first presentation at our institution. The primary outcome was long-term all-cause mortality. The regular multivariate Cox regression, restricted cubic spline, and two-piecewise model were used to explain the linear and curvilinear association between TTA and long-term mortality. The analyses were performed using EmpowerStats and R. Results: A total of 2361 patients were included in our study. There were 743 males and 1618 females, with a mean age of 79.44 ± 6.71 years. There were 1745 intertrochanteric fractures and 616 femoral neck fractures. We divided the patients into four groups according to TTA distribution: TTA ≤ 6 h, 6 h < TTA ≤ 12 h, 12 h < TTA ≤ 24 h, and TTA > 24 h, and the corresponding long-term mortality rates were 254 (25.53%), 85 (32.20%), 127 (32.56%), and 267 (37.50%). A curvilinear association was observed between TTA delay and long-term mortality in geriatric hip fractures, with 24 h serving as an inflection point. When TTA was less than 24 h, every one-hour increase in TTA was associated with a 1.6% increase in long-term mortality (HR = 1.016, 95% CI: 1.008–1.024; p < 0.001). When TTA exceeded 24 h, the long-term mortality risk showed no significant further increase with TTA (HR = 1.000, 95% CI: 1.000–1.000; p = 0.531). Conclusions: This study suggests that delayed admission is associated with a worse prognosis, and the mortality risk increases by approximately 1.6% per hour of delay within the first 24 h, after which the risk appears to stabilize. The first 24 h post-injury may represent a critical window for intervention. Full article

(This article belongs to the Special Issue Geriatric Fracture Care: Bridging Orthopedics and Gerontology)

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