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Medicina
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Increase in Geriatric Trauma: Current Knowledge and Future Solutions
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Increase in Geriatric Trauma: Current Knowledge and Future Solutions

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Geriatrics/Aging".

Deadline for manuscript submissions: closed (1 October 2023) | Viewed by 6312

Special Issue Editor

Prof. Dr. Matthias Knobe

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Guest Editor
1. Medical Faculty, University of Zurich, Zurich, Switzerland
2. RWTH Aachen University Hospital, Aachen, Germany
Interests: anchorage strategies in geriatric hip fracture management; fragility fracture; fall prevention; ortho-geriatric co-management; geriatric trauma center; medical education; biomechanical investigations; microcirculation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Geriatric trauma care is gaining more importance due to demographic changes. This growth in geriatric trauma patients presents a great challenge for the treating physicians. In addition to poor bone quality, which makes fracture fixation more difficult, comorbid conditions often lead to perioperative complications and hamper rehabilitation. Considering all these factors, geriatric trauma has great social and economic implications.

Surgical treatment should be straightforward and less invasive, allow immediate weight-bearing, and should be associated with a low complication rate. Various factors, such as patient age, comorbidities, activity level, age of the fracture or pre-injury arthrosis, and experience of the surgeon influence the decision-making for fixation. However, in recent years, cement augmentation strategies came to the fore and were discussed to an increasing degree. In addition, recent studies showed a benefit of the treatment of bone loss in proximal femurs of postmenopausal osteoporotic women with a local osteo-enhancement procedure which increased hip bone mineral density and hip strength to avoid hip fractures in the future.

The purpose of this Special Issue is to discuss the evidence for the fixation/prosthetic treatment of osteoporotic fractures in the elderly considering innovations and developments in the future as well. The scope of the Issue is deliberately broad in order to encourage the coverage of a wide range of topics and perspectives related to the management of geriatric fractures. This includes not only clinical treatments but also biomechanical considerations regarding implant anchorage, patient experience, epidemiology, service delivery, health promotion, complex co-management strategies in geriatric fracture care including fall prevention, and new interdisciplinary developments like the installation of a fracture liaison service or a geriatric fracture center. Promising first results of preventive minimally-invasive surgical interventions to treat osteoporotic bone loss and reduce hip fracture risk provide strong rationale for further clinical investigation.

Prof. Dr. Matthias Knobe
Guest Editor

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. Medicina is an international peer-reviewed open access monthly 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 1800 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

  • hip fracture
  • fracture fixation
  • implant anchorage
  • cement augmentation
  • co-management
  • fragility fracture
  • comorbidity
  • fall prevention
  • biomechanical investigation
  • geriatric fracture center

Published Papers (4 papers)

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11 pages, 2804 KiB  
Article
Value of Proximal Femur Geometry in Predicting Occult Hip Fracture
by Ulf Bökeler, Ulrich Liener, Nils Vogeley, Benjamin Mayer, Cornelia Horsch, Fridolin Tröster, Daphne Eschbach, Steffen Ruchholtz and Tom Knauf
Medicina 2023, 59(11), 1987; https://doi.org/10.3390/medicina59111987 - 11 Nov 2023
Cited by 1 | Viewed by 893
Abstract
Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this [...] Read more.
Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this study was to determine whether changes in the proximal femur geometry can predict the likelihood of an occult hip fracture in patients presenting with hip pain following a ground-level fall. Material and Methods: Patients admitted to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a seven-year period were included. All patients were additionally investigated with an MRI scan, and retrospectively, six radiologic parameters were obtained on plain radiographs: The cortical thickness index (CTI), the canal to calcar ratio (CCR), the canal flare index (CFI), the morphological cortical index (MCI), the canal bone ratio (CBR) and the canal bone aria ratio (CBAR). Subsequently the result of the plain radiographic indices of the patients with a negative MRI (Group A, no occult fracture) were compared to those with a positive MRI (Group B, occult fracture). Results: A total of 78 patients (59 female, 19 male) could be included in the study. The mean age was 82 years. The univariate analyses revealed a poor predictive ability of all radiological parameters with AUC values ranging from 0.515 (CBR) to 0.626 (CTI), whereas a multivariate prognostic model demonstrated improved prognosis (AUC = 0.761) for the CTI (p = 0.024), CBAR (p = 0.074) and CRR (p = 0.081) as the most promising predictive radiological parameters. Conclusions: Single radiologic indices obtained from conventional X-rays of the proximal femur have a weak predictive value in detecting occult fractures of the hip and cannot be used as clinical decision-making factors. Full article
(This article belongs to the Special Issue Increase in Geriatric Trauma: Current Knowledge and Future Solutions)
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11 pages, 1252 KiB  
Article
Complication and Infection Risk Using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients: An Observational Study
by Jonas Pawelke, Vithusha Vinayahalingam, Thaqif El Khassawna, Christian Heiss, Larissa Eckl and Gero Knapp
Medicina 2023, 59(2), 365; https://doi.org/10.3390/medicina59020365 - 14 Feb 2023
Cited by 4 | Viewed by 1260
Abstract
Background and Objectives: he treatment of large bone defects in geriatric patients often presents a major surgical challenge because of age-related bone loss. In such patients, the scarcity of healthy makes autologous grafting techniques hard to perform. On the one hand, clinicians’ fear [...] Read more.
Background and Objectives: he treatment of large bone defects in geriatric patients often presents a major surgical challenge because of age-related bone loss. In such patients, the scarcity of healthy makes autologous grafting techniques hard to perform. On the one hand, clinicians’ fear of possible infections limits using bone substitute materials (BSM). On the other hand, BSM is limitless and spares patients another surgery to harvest autologous material. Materials and Methods: To address the aptness of BSM in geriatric patients, we performed a retrospective analysis of all patients over the age of 64 years who visited our clinic between the years 2011–2018. The study assessed postoperative complications clinically and healing results radiologically. The study included 83 patients with bone defects at the distal radius, proximal humerus, and proximal tibia. The defect zones were filled with BSM based on either nanocrystalline hydroxyapatite (NHA) or calcium phosphate (CP). For comparison, a reference group (empty defect, ED) without the void filling with a BSM was also included. Results: 106 patients sustained traumatic fractures of the distal radius (71.7%), proximal humerus (5.7%), and proximal tibia (22.6%). No difference was found between the BSM groups in infection occurrence (p = 1.0). Although not statistically significant, the BSM groups showed a lower rate of pseudarthrosis (p = 0.09) compared with the ED group. Relative risk (RR) of complications was 32.64% less in the BSM groups compared with the ED group. The additional beneficial outcome of BSM was demonstrated by calculating the number needed to treat (NNT). The calculation showed that with every six patients treated, at least one complication could be avoided. Radiological assessment of bone healing showed significant improvement in the bridging of the defect zone (p < 0.001) when BSM was used. Conclusions: In contrast to previous studies, the study showed that BSM could support bone healing and does not present an infection risk in geriatric patients. The NNT calculation indicates a wider potential benefit of BSM. Full article
(This article belongs to the Special Issue Increase in Geriatric Trauma: Current Knowledge and Future Solutions)
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13 pages, 967 KiB  
Article
Comparison of Trabecular Bone Score–Adjusted Fracture Risk Assessment (TBS-FRAX) and FRAX Tools for Identification of High Fracture Risk among Taiwanese Adults Aged 50 to 90 Years with or without Prediabetes and Diabetes
by Tzyy-Ling Chuang, Mei-Hua Chuang, Yuh-Feng Wang and Malcolm Koo
Medicina 2022, 58(12), 1766; https://doi.org/10.3390/medicina58121766 - 30 Nov 2022
Cited by 2 | Viewed by 2134
Abstract
Background and Objectives: The burden of osteoporosis is projected to increase. Identification and prompt intervention for osteoporotic fractures are important. Adjusting the Fracture Risk Assessment (FRAX®) tool with trabecular bone score (TBS) could improve risk prediction. However, little is known about [...] Read more.
Background and Objectives: The burden of osteoporosis is projected to increase. Identification and prompt intervention for osteoporotic fractures are important. Adjusting the Fracture Risk Assessment (FRAX®) tool with trabecular bone score (TBS) could improve risk prediction. However, little is known about whether TBS-adjusted FRAX® would change the proportion of individuals qualified for osteoporosis intervention. Therefore, the aim of the present study was to compare the proportions of Taiwanese adults who qualified for intervention, according to the FRAX® and TBS-adjusted FRAX®, with stratification by sex, age group, and glucose regulation status. Materials and Methods: A medical record review on adults 50–90 years who had undergone a general health examination in a regional hospital in Taiwan was conducted. FRAX® and TBS-adjusted FRAX® were calculated. FRAX® cut-points of ≥ 20% for major osteoporotic fracture and ≥3% for hip fracture were adopted to identify individuals qualified for osteoporosis intervention. Individuals were classified as prediabetes and diabetes if their HbA1c was 5.7–6.4% and >6.4%, respectively. Results: A total of 8098 individuals with a mean age of 61.0 years were included. The proportion of men qualified for intervention for hip fracture was significantly lower according to TBS-adjusted FRAX® (17.2%) compared with FRAX® (20.7%) (p < 0.001), with a similar pattern across all three age groups and in those with prediabetes. In contrast, the proportion of women qualified for intervention for major osteoporotic fracture was significantly higher according to TBS-adjusted FRAX® (4.6%) compared with FRAX® (3.7%) (p < 0.001), particularly among those with prediabetes 60–69 years. Conclusions: TBS-adjusted FRAX® led to small but significant changes in the proportions of individuals qualified for intervention in specific age groups and glucose regulation status. Full article
(This article belongs to the Special Issue Increase in Geriatric Trauma: Current Knowledge and Future Solutions)
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15 pages, 6527 KiB  
Systematic Review
Quality of Life and Pain after Proximal Humeral Fractures in the Elderly: A Systematic Review
by Janette Iking, Karen Fischhuber, Josef Stolberg-Stolberg, Michael J. Raschke, Jan Christoph Katthagen and Jeanette Köppe
Medicina 2023, 59(10), 1728; https://doi.org/10.3390/medicina59101728 - 27 Sep 2023
Viewed by 1550
Abstract
Background and Objectives: The proximal humeral fracture (PHF) is one of the most common fractures in elderly patients. A PHF might influence the quality of life (QoL) on several different levels, especially in elderly patients, but it is unclear which treatment option results [...] Read more.
Background and Objectives: The proximal humeral fracture (PHF) is one of the most common fractures in elderly patients. A PHF might influence the quality of life (QoL) on several different levels, especially in elderly patients, but it is unclear which treatment option results in a better QoL outcome. Therefore, we aimed to systematically review the current literature for studies that have analyzed the QoL and pain of elderly patients treated either surgically or non-operatively for PHF. Materials and Methods: A comprehensive search of the literature was performed in the PubMed database from January to April 2023. Studies describing the QoL or the level of pain of patients older than 60 years with the EuroQoL-5 Dimension (EQ-5D) score or the visual analogue scale (VAS) after the treatment of PHF, either non-operatively (non-OP), with open-reduction and internal fixation using a locking plate (LPF), or with reverse total shoulder arthroplasty (RTSA) were included. Twelve studies were analyzed descriptively and the individual risk of bias was assessed using the ROB2 and ROBINS-I tools. Results: A total of 12 studies with 712 patients at baseline were included (78% female sex, mean age 75.2 years). The reported VAS scores at 12-month follow-up (FU) ranged from 0.7 to 2.5. The calculated overall mean VAS score across all studies showed a decreasing tendency for all treatments, with an increasing FU time up to 12 months after PHF. None of the studies reported any significant differences of the EQ-5D across the groups. The overall calculated EQ-5D indices showed an increasing trend after 6–8 weeks FU, but did not differ significantly between the three treatments. Conclusions: In conclusion, the current literature suggests that there are no clinically important differences between the QoL or pain in elderly patients with PHF after non-operative treatment or surgical treatment with LPF or RTSA. However, the number of studies and level of evidence is rather low and further trials are urgently needed. Full article
(This article belongs to the Special Issue Increase in Geriatric Trauma: Current Knowledge and Future Solutions)
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