Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Julius Wolff Institute, Berlin Institute of Health at Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Eur J Med Res. 2021 Aug 4;26(1):86. doi: 10.1186/s40001-021-00556-0.
As one of the leading causes of elderly patients' hospitalisation, proximal femur fractures (PFFs) will present an increasing socioeconomic problem in the near future. This is a result of the demographic change that is expressed by the increasing proportion of elderly people in society. Peri-operative management must be handled attentively to avoid complications and decrease mortality rates. To deal with the exceptional needs of the elderly, the development of orthogeriatric centres to support orthogeriatric co-management is mandatory. Adequate pain medication, balanced fluid management, delirium prevention and the operative treatment choice based on comorbidities, individual demands and biological rather than chronological age, all deserve particular attention to improve patients' outcomes. The operative management of intertrochanteric and subtrochanteric fractures favours intramedullary nailing. For femoral neck fractures, the Garden classification is used to differentiate between non-displaced and displaced fractures. Osteosynthesis is suitable for biologically young patients with non-dislocated fractures, whereas total hip arthroplasty and hemiarthroplasty are the main options for biologically old patients and displaced fractures. In bedridden patients, osteosynthesis might be an option to establish transferability from bed to chair and the restroom. Postoperatively, the patients benefit from early mobilisation and early geriatric care. During the COVID-19 pandemic, prolonged time until surgery and thus an increased rate of complications took a toll on frail patients with PFFs. This review aims to offer surgical guidelines for the treatment of PFFs in the elderly with a focus on pitfalls and challenges particularly relevant to frail patients.
作为导致老年患者住院的主要原因之一，股骨近端骨折（PFF）在不久的将来将成为一个日益严重的社会经济问题。这是人口结构变化的结果，表现为社会中老年人比例的增加。围手术期管理必须谨慎处理，以避免并发症和降低死亡率。为了满足老年人的特殊需求，必须发展矫形老年医学中心以支持矫形老年共管。充分的止痛药物、平衡的液体管理、预防谵妄以及根据合并症、个体需求和生物学而不是年龄选择手术治疗，所有这些都值得特别关注，以改善患者的预后。股骨转子间和转子下骨折的手术治疗倾向于髓内钉固定。对于股骨颈骨折，采用 Garden 分类来区分无移位和移位骨折。对于生物年轻、无移位骨折的患者，骨合成是合适的选择，而对于生物年老、移位骨折的患者，全髋关节置换和半髋关节置换是主要选择。对于卧床不起的患者，骨合成可能是从床上转移到椅子和浴室的一种选择。术后，患者受益于早期活动和早期老年护理。在 COVID-19 大流行期间，手术时间延长，导致并发症发生率增加，这对患有股骨近端骨折的体弱患者造成了影响。本文旨在为老年股骨近端骨折患者的治疗提供手术指南，重点关注与体弱患者特别相关的陷阱和挑战。
