Division of General Internal Medicine, Department of Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
Department of Geriatric Medicine, Zuyderland Medical Centre, Heerlen, the Netherlands.
J Am Med Dir Assoc. 2024 Oct;25(10):105191. doi: 10.1016/j.jamda.2024.105191. Epub 2024 Aug 5.
Hip fractures significantly impact morbidity and mortality among frail older adults, posing ongoing challenges in orthogeriatric care despite significant advancements. Established in the 1960s by Devas and Irvine, this field integrates orthopedics, trauma services, and geriatric medicine to address the complex needs of this population comprehensively. A critical and underexplored aspect is the precise identification and tailored treatment of various fracture types, each linked to unique clinical challenges and outcomes. This special article emphasizes the complex interplay between specific fracture types, their management options, and the roles of comorbidity and polypharmacy, highlighting the essential role of orthogeriatricians. Orthogeriatricians navigate the complexities posed by comorbidities, frailty, and polypharmacy, significantly influencing treatment outcomes. Their roles have expanded to include decision making about both operative and nonoperative strategies, emphasizing patient-centered care and moving beyond simplistic categorizations of "hip fractures." As future experts on the nuances of fracture types and their broader health implications, orthogeriatricians are also crucial in advancing treatment protocols that address preoperative and postoperative needs. Their comprehensive knowledge ensures effective in-hospital management and postdischarge planning, aligning treatment strategies with the holistic needs of frail older adults. The ongoing evolution of orthogeriatric practices promises to enhance decision-making and patient outcomes through a more informed and integrated care approach.
髋部骨折严重影响体弱老年人的发病率和死亡率,尽管在矫形骨科护理方面取得了重大进展,但仍存在持续挑战。该领域由 Devas 和 Irvine 于 20 世纪 60 年代创立,将矫形外科、创伤服务和老年医学整合在一起,全面满足这一人群的复杂需求。一个关键但尚未得到充分探索的方面是准确识别和针对性治疗各种骨折类型,每种类型都与独特的临床挑战和结果相关。这篇专题文章强调了特定骨折类型之间的复杂相互作用、它们的治疗选择以及合并症和多药治疗的作用,突出了矫形骨科医生的重要作用。矫形骨科医生应对合并症、虚弱和多药治疗带来的复杂性,对治疗结果有重大影响。他们的角色已经扩大,包括对手术和非手术策略的决策,强调以患者为中心的护理,并超越“髋部骨折”的简单分类。作为对骨折类型及其更广泛健康影响细微差别的未来专家,矫形骨科医生在制定解决术前和术后需求的治疗方案方面也至关重要。他们的综合知识确保了有效的院内管理和出院后计划,使治疗策略与体弱老年人的整体需求保持一致。矫形骨科实践的不断发展有望通过更具信息性和综合性的护理方法来提高决策和患者的结果。