Paradigm shift in geriatric fracture treatment

Rommens, Pol Maria

doi:10.1007/s00068-019-01080-x

Cited by 30 publications

(22 citation statements)

References 49 publications

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“…The authors also highlight that less invasive fixation is desirable for FFPs. The goal of Type IIIA FFP is recovery of function and stability, which is considered more important than achieving complete anatomical reduction 4,15 .…”

Section: Discussionmentioning

confidence: 99%

Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

Okazaki

Shirahama

Hashida

et al. 2020

Sci Rep

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There have been few reports on fixation of Rommens classification Type IIIA fragility fractures of the pelvis (FFPs). Here, we present our less invasive surgical technique, called iliac intramedullary stabilization (ILIS), for the internal fixation of Type IIIA FFPs. The technique involves a closed reduction, termed the femur internal rotation reduction method (FIRM), whereby the fracture fragments are repositioned using lateral rotators by internally rotating the femur while the patient is in the prone position. Two iliac screws are inserted on the ilium bilaterally via the supra-acetabular bone canal during FIRM and connected with two transverse rods and two cross connectors. We refer to this internal fixation procedure as ILIS. We retrospectively recruited patients with Type IIIA fractures, treated using this procedure, at our institute between October 2017 and October 2019. We evaluated operative and post-operative outcomes. We enrolled 10 patients (9 women and 1 man; mean age, 85.2 years) who were followed up for over 6 months. All patients suffered FFPs after falling from a standing position. The mean operative time was 145.1 (range, 94–217) minutes, and the mean blood loss was 258.5 (range, 100–684) ml. All patients were allowed full weight bearing from post-operative day 1. All patients achieved bone union and regained their pre-injury walking ability at 6 months after surgery without evident secondary displacement. In conclusion, our ILIS technique allows less invasive internal fixation of Type IIIA FFPs with adequate stability for full weight bearing from post-operative day 1.

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Section: Discussionmentioning

confidence: 99%

Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

Okazaki

Shirahama

Hashida

et al. 2020

Sci Rep

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“…Increasing age substantially increases the prevalence of comorbidities and the decline in organ function (heart, lung, kidneys, and liver). This makes elderly individuals much more vulnerable to post-traumatic complications and necessitates quick and minimally invasive surgery as well as rapid mobilization [4]. In terms of fracture fixation, this again requires sufficient mechanical stability to immediately mobilize the patient.…”

Section: Introductionmentioning

confidence: 99%

Biomechanics of Osteoporotic Fracture Fixation

Hollensteiner

Sandriesser

Bliven

et al. 2019

Curr Osteoporos Rep

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Purpose of Review Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures. Recent Findings Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Summary Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.

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“…Moreover, a conservative treatment from the beginning would have led to a long period of immobilization. Long-term immobilization of geriatric patients leads to a loss of independency and participation in the activities of daily life [13].…”

Section: Discussionmentioning

confidence: 99%

Osteosynthesis of a Multifragment Femoral Shaft Fracture and Peri-Implant Refracture in an 83-Year-Old Patient with Osteogenesis Imperfecta

Ballhause

Gessler

Priemel

et al. 2020

Case Reports in Orthopedics

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Introduction. Osteogenesis imperfecta (OI) is the term for a heterogenic group of conatal diseases that affect the bone formation. Eight different OI types are known. Patients with types III and IV frequently suffer from fractures without adequate trauma. The literature gives plenty advice for fracture treatment in pediatric OI patients, but there is less for adults, and no recommendations can be found for geriatric OI patients. Case Presentation. We report on an 83-year-old male who suffered from OI type IV. He was able to walk with an individually adapted gait orthosis. In an accident, the patient sustained a distal, multifragment, femoral shaft fracture. The fracture was openly reduced and fixated with a retrograde inserted elastic stable intramedullary nail (ESIN). Three months later, the patient was capable of walking without crutches. Due to another accident, he sustained a peri-implant refracture without failure of the ESIN. We immobilized the leg, and it achieved bony healing without reosteosynthesis. Eleven weeks later, he was again able to mobilize himself with full weight bearing. Discussion. We present a unique case of osteosynthesis in a distal, multifragment, femoral shaft fracture in a geriatric OI patient. No recommendations for the treatment of mature patients with OI can be found in the literature. We present our treatment concept and technique of osteosynthesis with an ESIN. Despite another accident with a peri-implant refracture, sufficient bony healing occurred, which allowed the patient to freely mobilize himself again.

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Paradigm shift in geriatric fracture treatment

Cited by 30 publications

References 49 publications

Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

Biomechanics of Osteoporotic Fracture Fixation

Osteosynthesis of a Multifragment Femoral Shaft Fracture and Peri-Implant Refracture in an 83-Year-Old Patient with Osteogenesis Imperfecta

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