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Geriatric Fracture: Current Treatment and Future Options
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Geriatric Fracture: Current Treatment and Future Options

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

Deadline for manuscript submissions: 20 December 2024 | Viewed by 3126

Special Issue Editors

Dr. Detlef Van der Velde

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Guest Editor
Department of Geriatric Trauma, St. Antonius Hospital, Utrecht, The Netherlands
Interests: geriatric trauma; trauma surgery; general surgery; trauma care; healthcare innovation; value-based healthcare
Dr. Henk Jan Schuijt

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Guest Editor
Department of Geriatric Trauma, St. Antonius Hospital, Utrecht, The Netherlands
Interests: geriatric trauma; older adult medicine; trauma surgery; value-based healthcare; implementation science

Special Issue Information

Dear Colleagues,

The age group of older adults is growing rapidly worldwide and is expected to continue to grow. Geriatric traumatology is a rapidly growing subspecialty within orthopedic trauma surgery, and there is increasing demand for scientific studies in this field. Medical decision-making for frail geriatric fracture patients is complex, especially toward the end of life. For example, recent studies in this field have shown that surgery may not always be the best option for very frail geriatric hip fracture patients. The “one-size fits all” approach simply does not apply in geriatric trauma.

If we are to provide patient centered for older adults with fractures, there is need for more insight into treatment options and patient (reported) outcomes, as well as costs. These insights are vital for the advancement of data-driven and value-based healthcare in this field.

For this Special Issue, we welcome authors to submit papers on current treatment options (both operative and non-operative) and patient outcomes for geriatric patients with fractures. We highly recommend research to be conducted by a multidisciplinary team. Additionally, we seek to promote inclusiveness for patients with cognitive impairment. These patients are often selectively excluded from studies in this field, while they might benefit most from them. We look forward to your submissions.

Dr. Detlef Van der Velde
Dr. Henk Jan Schuijt
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • geriatric trauma
  • trauma surgery
  • orthopedic surgery
  • fractures
  • frailty
  • osteoporosis
  • older adult medicine

Published Papers (4 papers)

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11 pages, 863 KiB  
Article
Beyond Mortality: Severely Frail Femur Fracture Patients Can Regain Independence after Surgery
by Noa H. M. Ponds, Jochem H. Raats, Devon T. Brameier, Henk Jan Schuijt, Lisa Cooper, Abigail Sagona, Houman Javedan and Michael J. Weaver
J. Clin. Med. 2024, 13(11), 3197; https://doi.org/10.3390/jcm13113197 - 29 May 2024
Viewed by 341
Abstract
Objectives: Little is known about the post-operative functional outcomes of severely frail femur fracture patients, with previous studies focusing on complications and mortality. This study investigated patient- or proxy-reported outcomes after femur fracture surgery in older adult patients with severe frailty. Methods: This [...] Read more.
Objectives: Little is known about the post-operative functional outcomes of severely frail femur fracture patients, with previous studies focusing on complications and mortality. This study investigated patient- or proxy-reported outcomes after femur fracture surgery in older adult patients with severe frailty. Methods: This was a retrospective cross-sectional study of older adult (>70 years) patients with severe frailty (defined by a Comprehensive Geriatric Assessment-based Frailty Index (FI-CGA) ≥ 0.40), who underwent femur fracture surgery at a Level 1 Trauma Center. Patients or their proxy (i.e., close relative) reported mobility, psychosocial, and functional outcomes at least 1-year after surgery. Results: Thirty-seven predominantly female (76%) patients with a median age of 85 years (IQR 79–92), and a median FI-CGA of 0.48 (IQR 0.43–0.54) were included. Eleven patients (30%) regained pre-fracture levels of ambulation, with twenty-six patients (70%) able to walk with or without assistance. The majority of patients (76%) were able to have meaningful conversations. Of the patients, 54% of them experienced no to minimal pain, while 8% still experienced a lot of pain. Functional independence varied, as follows: five patients (14%) could bathe themselves; nine patients (25%) could dress themselves; fourteen patients (39%) could toilet independently; and seventeen patients (47%) transferred out of a (wheel)chair independently. Conclusions: Despite the high risk of mortality and perioperative complications, many of the most severely frail patients with surgically treated femur fractures regain the ability to ambulate and live with a moderate degree of independence. This information can help healthcare providers to better inform these patients and their families of the role of surgical treatment during goals of care discussions. Full article
(This article belongs to the Special Issue Geriatric Fracture: Current Treatment and Future Options)
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11 pages, 662 KiB  
Article
The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study
by Thomas Nijdam, Tim Schiepers, Duco Laane, Henk Jan Schuijt, Detlef van der Velde and Diederik Smeeing
J. Clin. Med. 2024, 13(7), 2012; https://doi.org/10.3390/jcm13072012 - 29 Mar 2024
Viewed by 733
Abstract
(1) Background: Hip fracture patients with very limited life expectancy can opt for non-operative management (NOM) within a palliative care context. The implementation of NOM in the palliative context may affect the mortality of the operatively treated population. This retrospective cohort study aimed [...] Read more.
(1) Background: Hip fracture patients with very limited life expectancy can opt for non-operative management (NOM) within a palliative care context. The implementation of NOM in the palliative context may affect the mortality of the operatively treated population. This retrospective cohort study aimed to determine whether the operatively treated geriatric hip fracture population would have a lower in-hospital mortality rate and fewer postoperative complications after the introduction of NOM within a palliative care context for patients with very limited life expectancy. (2) Methods: Data from 1 February 2019 to 1 February 2022 of patients aged 70 years or older were analyzed to give a comparison between patients before and after implementation of NOM within a palliative care context. (3) Results: Comparison between 550 patients before and 485 patients after implementation showed no significant difference in in-hospital or 1-year mortality rates (2.9% vs. 1.4%, p = 0.139; 22.4% vs. 20.2%, p = 0.404, respectively). Notably, post-implementation, fewer patients had prior dementia diagnoses (15% vs. 21%, p = 0.010), and intensive care unit admissions decreased (3.5% vs. 1.2%, p = 0.025). (4) Conclusions: The implementation of NOM within a palliative care context did not significantly reduce mortality or complications. However, NOM within palliative care is deemed a more patient-centered approach for geriatric hip fracture patients with very limited life expectancy. Full article
(This article belongs to the Special Issue Geriatric Fracture: Current Treatment and Future Options)
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23 pages, 2426 KiB  
Article
Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery?
by Michael Bui, Catharina G. M. Groothuis-Oudshoorn, Annemieke Witteveen and Johannes H. Hegeman
J. Clin. Med. 2024, 13(6), 1594; https://doi.org/10.3390/jcm13061594 - 11 Mar 2024
Viewed by 1053
Abstract
Background: For hip fracture patients with a limited life expectancy, operative and palliative non-operative management (P-NOM) can yield similar quality of life outcomes. However, evidence on when to abstain from surgery is lacking. The aim of this study was to quantify the influence [...] Read more.
Background: For hip fracture patients with a limited life expectancy, operative and palliative non-operative management (P-NOM) can yield similar quality of life outcomes. However, evidence on when to abstain from surgery is lacking. The aim of this study was to quantify the influence of patient characteristics on surgeons’ decisions to recommend P-NOM. Methods: Dutch surgical residents and orthopaedic trauma surgeons were enrolled in a conjoint analysis and structured expert judgement (SEJ). The participants assessed 16 patient cases comprising 10 clinically relevant characteristics. For each case, they recommended either surgery or P-NOM and estimated the 30-day postoperative mortality risk. Treatment recommendations were analysed using Bayesian logistic regression, and perceived risks were pooled with equal and performance-based weights using Cooke’s Classical Model. Results: The conjoint analysis and SEJ were completed by 14 and 9 participants, respectively. Participants were more likely to recommend P-NOM to patients with metastatic carcinomas (OR: 4.42, CrI: 2.14–8.95), severe heart failure (OR: 4.05, CrI: 1.89–8.29), end-stage renal failure (OR: 3.54, CrI: 1.76–7.35) and dementia (OR: 3.35, CrI: 1.70–7.06). The patient receiving the most P-NOM recommendations (12/14) had a pooled perceived risk of 30-day mortality between 50.8 and 62.7%. Conclusions: Overall, comorbidities had the strongest influence on participants’ decisions to recommend P-NOM. Nevertheless, practice variation and heterogeneity in risk perceptions were substantial. Hence, more decision support for considering P-NOM is needed. Full article
(This article belongs to the Special Issue Geriatric Fracture: Current Treatment and Future Options)
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12 pages, 541 KiB  
Systematic Review
Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review
by Thomas P. Bosch, Frank J. P. Beeres, Steven Ferree, Inger B. Schipper, Roland S. Camenzind, Ruben J. Hoepelman, Björn-Christian Link, Ingmar F. Rompen, Reto Babst and Bryan J. M. van de Wall
J. Clin. Med. 2024, 13(11), 3344; https://doi.org/10.3390/jcm13113344 - 6 Jun 2024
Viewed by 403
Abstract
Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two [...] Read more.
Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant–Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions. Full article
(This article belongs to the Special Issue Geriatric Fracture: Current Treatment and Future Options)
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