Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly

Abstract

Currently, there is a wide awareness of the high degree of functional impairment and morbimortality associated with hip fractures in the elderly, and efforts are being made to improve outcomes. As age rises, physiological reserves decline, and more severe complications occur. Simultaneous bilateral extracapsular hip fractures in the setting of low-energy trauma in the elderly are rare but deserve special attention with treatment strategies that are in between those for unilateral hip fractures and elderly patients with multiple injuries. Adequate initial assessment, a multidisciplinary approach to trauma care, and the integration of medical and orthopaedic surgical attention are paramount. Furthermore, there is a need for early single-stage surgical fixation in medically stable patients and optimization of patients who are unfit. Despite some variations from unilateral cases, the main objective remains to achieve painless hips and stable fixation for early mobilization with the lowest morbidity and mortality rates. General anesthesia for intramedullary nailing using short nonreamed nails for stable fracture patterns and minimal reaming when long nails are used may be regarded as the best option. Physicians should be cautious of the higher risk of complications such as blood loss, fat embolism syndrome, and adult respiratory distress syndrome. Orthogeriatric management and multidisciplinary teams may also improve outcomes, as demonstrated for unilateral hip fractures. Secondary prevention of fractures is promoted through the prescription of antiosteoporotic treatment, nutritional assessment, and skills training. This literature review aims to help optimize the management of patients with simultaneous bilateral extracapsular hip fractures, outlining the differential concerns with respect to unilateral cases.

Simultaneous bilateral extracapsular proximal femur fractures in the elderly. A case report

“…PFF entails considerable individual, social and economic impact, mainly due to its high incidence in the elderly and associated functional impairment [ 2 ]. The lifetime risk of unilateral hip fracture is estimated to be high, ranging from 40 to 50% in women and from 13 to 22% in men [ 3 ].…”

“…The lifetime risk of unilateral hip fracture is estimated to be high, ranging from 40 to 50% in women and from 13 to 22% in men [ 3 ]. However, bilateral and simultaneous PFF are rare and hardly described in the literature [ 2 ]. In fact, only 23 bilateral and simultaneous extracapsular or combined intra-extracapsular PFF cases have been reported to date ( Table 1 ).…”

“…[ 4 ] reported eight cases over 10 years, the estimated frequency being 0.3% of the total number of hip fractures attended, while Verma et al., [ 5 ] in their series of 4 cases over 3 years, estimate a similar rate of 0.24%. This low reported incidence challenges the acquisition of experience in the management of these combined fractures; therefore, only one literature review on its management has been described to date [ 2 ].…”

“…Proper medical and surgical stabilization, in addition to early mobilization, are priorities. Minimal reaming and careful nailing can be safely performed bilaterally under close monitoring, allowing the surgery to be performed at one time in order to start an early functional recovery [ 2 ].…”

Uso de técnicas de imagen en la planificación quirúrgica de fracturas complejas de tibia

“…La preparación minuciosa previa a una intervención quirúrgica constituye un acto fundamental que no debe obviarse, en un intento por conseguir los mejores resultados para los pacientes. (Galán-Olleros et al, 2022) Desde la invención de los Rayos X, el uso de la imagen para complementar el diagnóstico clínico de múltiples patologías no ha hecho más que progresar y cobrar importancia. Un hito histórico en la medicina moderna fue la implementación de la tecnología TAC y RMN en la práctica médica habitual.…”