Orthogeriatric care—outcome of different fragility fractures

Abstract

Introduction Fragility fractures (FF) are associated with increased morbidity and mortality and reflect a dramatic turning point in the life of older adults. The scientific discourse is dominated by proximal femoral fractures, but FF affect multiple parts of the body and often precede hip fractures. Orthogeriatric co-management has multiple shown to improve patient’s outcome. We hypothesize that all geriatric patients with FF benefit from orthogeriatric co-management. Materials and methods We retrospectively evaluated all patients over 70 years with FF (hip joint, periprosthetic, spine, pelvic ring, and humerus) of our geriatric trauma center for the years 2019–2021, who received orthogeriatric co-management. Demographic data, fracture type, complications, discharge modality and in-hospital mortality were recorded. For patients transferred to geriatrics, the Barthel Index (BI) and the discharge modality were recorded. Primary outcome parameters were discharge modality and BI difference. Secondary outcome parameters were complication rates and in-hospital mortality. Logistic regression analysis was performed. Results 555 patients (83.8 ± 6.5 years, 182 males, 373 females) were evaluated. 245 (44.1%) patients were referred to geriatrics for further orthogeriatric treatment. Positive predictors were age, surgery, and a high Charlson Comorbidity Index. The overall in-hospital mortality was 8.6% (n = 48) (5.8% (n = 32) during acute trauma care and 6.5% (n = 16) during stay in geriatrics). The mortality rate of nursing home residents was significantly higher compared to patients living at home (10.4% vs. 5.6%). The rate of non-surgical complications was 44.5%. 26.9% of patients living at home were discharged to a nursing home, while 51.3% were able to return home. The risk of admission to a nursing home was reduced for thoracolumbar fractures (OR = 0.22) and increased markedly for periprosthetic fractures (OR = 3.95). During orthogeriatric treatment, all fractures showed a significant increase in BI. Patients living at home benefited more than nursing home residents (20.5 ± 19.5 vs. 8.7 ± 18.0 points). The chance of a BI increase (> 19 points) was increased for hip and pelvic ring fractures. Devastating results showed patients with dementia. In comparison, mentally healthy patients had a 4.5-fold increased chance of increasing their BI (> 19 points). Conclusions Presented data shows that all patients with FF are at high risk for complications and could benefit from standardized orthogeriatric management. Modern patient care requires a holistic orthogeriatric approach to improve patient’s outcome.

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population

“…A decline in NSSI frequency was also observed in patients with severe systemic disease, such that the trend of increasing ASA grade no longer met significance for predicting the development of NSSI in the current study population. Increasing ASA grade has previously been shown to predict post-operative morbidity and mortality in hip fractures [7,20,28,[36][37][38]. NSSI also decreased in patients admitted from nursing homes, which was no longer near significant in the current study period.…”

“…Frailty has also been demonstrated as a significant predictor of adverse post-operative outcomes, including increased mortality, post-operative complications, including NSSI, and increased length of hospital stay across various disciplines [29][30][31], including hip fracture surgery [32,33]. Previous studies demonstrate that severe cognitive impairment increases the risk of postoperative infection following hip fracture [20], particularly respiratory and urinary tract infections [34,35]. Here, the implementation of an orthogeriatric liaison model reduced infection frequency in this group.…”

“…Regular orthogeriatric input has been demonstrated to be associated with significant improvement in decreasing length of hospital stay, reduction of financial burden, decreased time to operation, reduced mortality, early mortality, and improvement in early mobility [15][16][17][18][19][20][21]. This study demonstrates that the implementation of regular orthogeriatric review is associated with a significant decrease in non-surgical site infections (NSSIs) only in individuals with severe cognitive impairment and infection-associated mortality.…”

“…Importantly, Lisk et al, 2023 showed that orthogeriatric liaison services were associated with a significant decrease in the length of hospital stay, and the introduction of the service was also linked to savings of EUR 2.7 million per 1000 patients [15]. Several studies have indicated that orthogeriatric liaison services are associated with improvements in the length of hospital stay, decreased time to surgery, reduced early mortality, and improvements in early mobility [16][17][18][19][20][21]. The success of orthogeriatric services in acute hospitals or rehabilitation units depends on its multidisciplinary approach, including nutritional support [22,23].…”

Biomechanical Evaluation of Unstable Intertrochanteric Fractures Fixation with Different Implants: A Finite Element Analysis Study

“…Intertrochanteric fractures account for about 53.7% of hip fractures, and the affected group is mainly the elderly, often due to falls [3]. Intertrochanteric fractures should be managed appropriately and treated as soon as possible, as most patients with this disease are advanced and carry many comorbidities, and without comprehensive evaluation and targeted treatment, they will face unpredictable and catastrophic consequences [4]. Intertrochanteric fractures are mainly treated with intraoperative xation, Strong internal xation can reduce pain, speed recovery, shorten hospital stay, reduce the occurrence of comorbidities such as fall pneumonia, deep vein thrombosis, and pressure sores, and improve postoperative survival and quality of life [5,6].…”