Rommens Pol Maria
Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany.
Eur J Trauma Emerg Surg. 2019 Apr;45(2):181-189. doi: 10.1007/s00068-019-01080-x. Epub 2019 Feb 6.
The number of geriatric patients is increasing. These patients exhibit specific characteristics, which influence the type of fracture care. Many patients have comorbidities, which make them more vulnerable to surgical procedures. The soft tissue envelope around the fracture often is compromised due to pre-existing diseases such as diabetes, chronic venous insufficiency or peripheral vascular disease. Bone mineral density has decreased, which enhances the risk of implant loosening. The goals of treatment differ from those, which are valid for younger adults. Primary goal is preserving independency of the elderly patient in his activities of daily life. Advantages and drawbacks of surgical procedures have to be balanced with those of conservative treatment. Fractures of the lower extremities will more often need surgical treatment than fractures of the upper extremities. Patient´s autonomy is best obtained by creating high stability in the fracture plane, which enables motion and weight-bearing. Second priority is prevention of general and local post-operative complications by the use of less invasive surgical procedures. Restoring anatomy and optimal function are less important goals. The implants, which are used, are inserted through small incisions, placed deep under the skin and use long anatomic or osseous corridors. Intramedullary devices have important advantages. This paradigm shift takes the special challenges and requirements of geriatric patients into account.
老年患者的数量正在增加。这些患者具有特定的特征，这会影响骨折治疗的类型。许多患者患有合并症，这使他们在手术过程中更容易出现问题。由于糖尿病、慢性静脉功能不全或外周血管疾病等既往疾病，骨折周围的软组织包膜往往受到损害。骨密度降低，这增加了植入物松动的风险。治疗目标与适用于年轻人的目标不同。主要目标是保持老年患者在日常生活活动中的独立性。手术治疗的优缺点必须与保守治疗的优缺点相权衡。下肢骨折比上肢骨折更常需要手术治疗。通过在骨折平面创造高稳定性来最好地实现患者的自主性，这能够实现活动和负重。其次是通过使用侵入性较小的手术来预防全身和局部术后并发症。恢复解剖结构和最佳功能是不太重要的目标。所使用的植入物通过小切口插入，置于皮肤深处，并使用长的解剖或骨通道。髓内装置具有重要优势。这种范式转变考虑到了老年患者的特殊挑战和需求。
