Orthogeriatric co-management: differences in outcome between major and minor fractures

Abstract

Purpose Literature shows that orthogeriatric co-management improves the outcomes of patients with hip fractures. Corresponding research with more diverse fragility fracture groups is lacking. Therefore, an examination was performed prospectively as a 2 year-follow-up on an orthogeriatric co-managed ward, comparing relevant outcome parameters for major and minor fragility fractures. Methods All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included and their injuries, orthogeriatric parameters such as the Barthel Index (BI), Parker Mobility Score (PMS) and place of residence (POR). Patients were separated into two groups of either immobilizing major (MaF) or non-immobilizing minor (MiF) fractures. 2 years later, a follow-up was conducted via telephone calls and questionnaires mailed to patients and/or their relatives. Results 740 (574 major vs. 166 minor injuries) patients were initially assessed, with a follow-up rate of 78.9%. The in-house, 1-year, and 2-year-mortality rates were 2.7, 27.4, and 39.2%, respectively. Mortality was significantly higher for MaF in the short term, but not after 2 years. On average, during the observation period, patients regained their BI by 36.7 points (95% CI: 33.80–39.63) and PMS was reduced by 1.4 points (95% CI: 1.16–1.68). No significant differences were found in the readmission rate, change in BI, PMS or POR between the MaF and MiF groups. Conclusion The relevance of orthogeriatric treatment to improving functional and socioeconomic outcomes was confirmed. The similarity of the results from both fracture groups emphasizes the need for a multidisciplinary approach also for minor fractures.

Orthogeriatric co-management for older patients with a major osteoporotic fracture: Protocol of an observational pre-post study

“…Yet, the body of evidence regarding the effectiveness of orthogeriatric co-management models is mainly based on patients with hip fractures [ 25 , 58 , 59 ]. Patients with non-hip fractures could also benefit from orthogeriatric co-management, however, the evidence is limited [ 26 ]. As such, a heterogenous population consisting of community-dwelling and non-community-dwelling patients with all types of major osteoporotic fractures will be included in the G-COMAN intervention and the evaluation in the G-COMAN Fractures study.…”

“…Geriatric-surgical co-management models for surgical patients (i.e., orthopedic surgery, gastro-intestinal surgery, and an acute surgery unit) have shown a beneficial impact on length of stay, mortality, and hospital readmission rates [ 24 ]. Moreover, evidence revealed that geriatric patients with all types of osteoporotic fractures could improve from orthogeriatric co-management [ 25 , 26 ].…”

Orthogeriatric care—outcome of different fragility fractures

“…Hip fractures clearly dominating the scientific discourse [ 11 ], but fragility fractures occur in multiple parts of the human body, such as humerus, pelvis, spine or wrist [ 12 ] and often precede devastating hip fractures [ 13 ]. Data on orthogeriatric care in the course of different fragility fractures is poor [ 14 ]. Here, we hypothesize that not only hip fracture patient benefit from orthogeriatric care.…”

The precise reconstruction of the center of rotation in total hip arthroplasty after femoral neck fractures - a clinically crucial challenge

“…The recovery of the daily living ability and optimal management of potential comorbidities is the central aim in the treatment of osteoporotic indicator fractures in the aging patient. Overall functional rehabilitation represents an important evaluation criterion in geriatric traumatology [4]. Because of socioeconomic considerations, possible prevention of long-term care dependency and due to the ethical assignment of a surgeon, it is particularly necessary to analyze our care strategies to regular quality assuring data analysis.…”