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Osteoporosis International

Erschienen in:

01.12.2010 | Review

How to optimize patients for geriatric fracture surgery

verfasst von: D. Marsland, P. L. Colvin, S. C. Mears, S. L. Kates

Erschienen in: Osteoporosis International | Sonderheft 4/2010

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Abstract

Low-energy fragility fractures account for >80% of fractures in elderly patients, and with aging populations, geriatric fracture surgery makes up a substantial proportion of the orthopedic workload. Elderly patients have markedly less physiologic reserve than do younger patients, and comorbidity is common. Even with optimal care, the risk of mortality and morbidity remains high. Multidisciplinary care, including early orthogeriatric input, is recommended to anticipate and treat complications. This article explores modern treatment strategies for this challenging group of patients and provides guidance for systematically preparing and optimizing elderly patients before surgery, based on best available current evidence and recommendations by relevant health organizations.

Mauck KF, Clarke BL (2006) Diagnosis, screening, prevention, and treatment of osteoporosis. Mayo Clin Proc 81:662–672CrossRefPubMed

Bergstrom U, Jonsson H, Gustafson Y, Pettersson U, Stenlund H, Svensson O (2009) The hip fracture incidence curve is shifting to the right: a forecast of the age-quake. Acta Orthop 80:520–524CrossRefPubMed

Lonner JH, Koval KJ (1995) Polytrauma in the elderly. Clin Orthop Relat Res 318:136–143PubMed

Oreskovich MR, Howard JD, Copass MK, Carrico CJ (1984) Geriatric trauma: injury patterns and outcome. J Trauma 24:565–569, discussion 569–572CrossRefPubMed

British Orthopaedic Association (2007) The care of patients with fragility fracture. British Orthopaedic Association, London

Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, Parker MJ, Payne BV, Rushton N (1995) Differences in mortality after fracture of hip: the east Anglian audit. BMJ 310:904–908PubMed

Scottish Intercollegiate Guidelines Network (2009) Management of hip fracture in older people. Scottish Intercollegiate Guidelines Network, Edinburgh

World Health Organization (2010) Definition of an older or elderly person. Available at http://www.who.int/healthinfo/survey/ageingdefnolder/en/index.html. Accessed 4 Jun 2010

Stedman TL (2000) Stedman’s medical dictionary. Lippincott Williams & Wilkins, Philadelphia

10.

Lewis JR, Hassan SKZ, Wenn RT, Moran CG (2006) Mortality and serum urea and electrolytes on admission for hip fracture patients. Injury 37:698–704CrossRefPubMed

11.

Roche JJW, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374. doi:1310.1136/bmj.38643.663843.663855 CrossRefPubMed

12.

Maxwell MJ, Moran CG, Moppett IK (2008) Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. Br J Anaesth 101:511–517CrossRefPubMed

13.

Paksima N, Koval KJ, Aharanoff G, Walsh M, Kubiak EN, Zuckerman JD, Egol KA (2008) Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis 66:111–117PubMed

14.

Barone A, Giusti A, Pizzonia M, Razzano M, Oliveri M, Palummeri E, Pioli G (2009) Factors associated with an immediate weight-bearing and early ambulation program for older adults after hip fracture repair. Arch Phys Med Rehabil 90:1495–1498CrossRefPubMed

15.

de Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 56:221–229CrossRefPubMed

16.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383CrossRefPubMed

17.

Zekry D, Loures Valle BH, Lardi C, Graf C, Michel JP, Gold G, Krause KH, Herrmann FR (2010) Geriatrics index of comorbidity was the most accurate predictor of death in geriatric hospital among six comorbidity scores. J Clin Epidemiol 63:1036–1044. doi:10.1016/j.jclinepi.2009.11.013 CrossRefPubMed

18.

Ramanathan TS, Moppett IK, Wenn R, Moran CG (2005) POSSUM scoring for patients with fractured neck of femur. Br J Anaesth 94:430–433CrossRefPubMed

19.

Lane N, Allen K (1999) Hyponatraemia after orthopaedic surgery. BMJ 318:1363–1364PubMed

20.

Sexson SB, Lehner JT (1987) Factors affecting hip fracture mortality. J Orthop Trauma 1:298–305CrossRefPubMed

21.

Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91:922–927CrossRefPubMed

22.

Rogers FB, Shackford SR, Keller MS (1995) Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma 39:261–265CrossRefPubMed

23.

Shiga T, Wajima Z, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 55:146–154CrossRefPubMed

24.

Siegmeth AW, Gurusamy K, Parker MJ (2005) Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br 87:1123–1126CrossRefPubMed

25.

Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL (2002) The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 112:702–709CrossRefPubMed

26.

Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489CrossRefPubMed

27.

Tornetta P III, Mostafavi H, Riina J, Turen C, Reimer B, Levine R, Behrens F, Geller J, Ritter C, Homel P (1999) Morbidity and mortality in elderly trauma patients. J Trauma 46:702–706CrossRefPubMed

28.

Bone LB, McNamara K, Shine B, Border J (1994) Mortality in multiple trauma patients with fractures. J Trauma 37:262–265CrossRefPubMed

29.

Johnson KD, Cadambi A, Seibert GB (1985) Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 25:375–384CrossRefPubMed

30.

Callum KG, Gray AJG, Hoile RW, Ingram GS, Martin IC, Sherry KM, Whimster F (1999) Extremes of age: the 1999 report of the National Confidential Enquiry into Perioperative Deaths. National Confidential Enquiry into Perioperative Deaths, London

31.

Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 315:909–912PubMed

32.

Price JD, Sear JJW, Venn RRM (2004) Perioperative fluid volume optimization following proximal femoral fracture. Cochrane Database Syst Rev 1:CD003004. doi:003010.001002/14651858.CD14003004.pub14651852 PubMed

33.

Parker MJ, Griffiths R, Appadu B (2002) Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev 1:CD001159. doi:001110.001002/14651858.CD14001159 PubMed

34.

Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH (2005) Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 173:627–634PubMed

35.

Auerbach AD, Goldman L (2002) beta-Blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA 287:1435–1444CrossRefPubMed

36.

Poise Study Group (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847CrossRef

37.

Fleisher LA, Eagle KA (2001) Lowering cardiac risk in noncardiac surgery. N Engl J Med 345:1677–1682CrossRefPubMed

38.

Domanski M, Ellis S, Eagle K (1995) Does preoperative coronary revascularization before noncardiac surgery reduce the risk of coronary events in patients with known coronary artery disease? [editorial]. Am J Cardiol 75:829–831CrossRefPubMed

39.

Groban L, Butterworth J (2006) Perioperative management of chronic heart failure. Anesth Analg 103:557–575CrossRefPubMed

40.

Rosenman DJ, McDonald FS, Ebbert JO, Erwin PJ, LaBella M, Montori VM (2008) Clinical consequences of withholding versus administering renin–angiotensin–aldosterone system antagonists in the preoperative period. J Hosp Med 3:319–325CrossRefPubMed

41.

Brabant SM, Bertrand M, Eyraud D, Darmon PL, Coriat P (1999) The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth Analg 89:1388–1392CrossRefPubMed

42.

Coriat P, Richer C, Douraki T, Gomez C, Hendricks K, Giudicelli JF, Viars P (1994) Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 81:299–307CrossRefPubMed

43.

Pigott DW, Nagle C, Allman K, Westaby S, Evans RD (1999) Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive drug requirements. Br J Anaesth 83:715–720PubMed

44.

Comfere T, Sprung J, Kumar MM, Draper M, Wilson DP, Williams BA, Danielson DR, Liedl L, Warner DO (2005) Angiotensin system inhibitors in a general surgical population. Anesth Analg 100:636–644CrossRefPubMed

45.

Chambers J (2005) Aortic stenosis [editorial]. BMJ 330:801–802CrossRefPubMed

46.

Scottish Hip Fractures Audit (2008) Clinical decision-making: is the patient fit for theatre? NHS National Services Scotland, Edinburgh

47.

McBrien ME, Heyburn G, Stevenson M, McDonald S, Johnston NJ, Elliott JRM, Beringer TRO (2009) Previously undiagnosed aortic stenosis revealed by auscultation in the hip fracture population—echocardiographic findings, management and outcome. Anaesthesia 64:863–870CrossRefPubMed

48.

National Confidential Enquiry into Perioperative Deaths (2001) The 2001 report of the National Confidential Enquiry into Perioperative Deaths. National Confidential Enquiry into Perioperative Deaths, London

49.

Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Tarkington LG, Yancy CW (2007) ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 50:e159–e242CrossRefPubMed

50.

Ricci WM, Della Rocca GJ, Combs C, Borrelli J Jr (2007) The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures. Injury 38:S49–S52CrossRefPubMed

51.

Gillespie WJ, Walenkamp GHIM (2001) Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev 1:CD000244. doi:000210.001002/14651858.CD14000244.pub14651852 PubMed

52.

Southwell-Keely JP, Russo RR, March L, Cumming R, Cameron I, Brnabic AJM (2004) Antibiotic prophylaxis in hip fracture surgery: a metaanalysis. Clin Orthop Relat Res 419:179–184CrossRefPubMed

53.

Dolan MM, Hawkes WG, Zimmerman SI, Morrison RS, Gruber-Baldini AL, Hebel JR, Magaziner J (2000) Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes. J Gerontol A Biol Sci Med Sci 55:M527–M534PubMed

54.

Gustafson Y, Brannstrom B, Norberg A, Bucht G, Winblad B (1991) Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients. J Am Geriatr Soc 39:760–765PubMed

55.

Dasgupta M, Dumbrell AC (2006) Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc 54:1578–1589CrossRefPubMed

56.

Inouye SK, Charpentier PA (1996) Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 275:852–857CrossRefPubMed

57.

Edlund A, Lundstrom M, Lundstrom G, Hedqvist B, Gustafson Y (1999) Clinical profile of delirium in patients treated for femoral neck fractures. Dement Geriatr Cogn Disord 10:325–329CrossRefPubMed

58.

Marcantonio ER, Flacker JM, Wright RJ, Resnick NM (2001) Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 49:516–522CrossRefPubMed

59.

Sieber FE, Gottshalk A, Zakriya KJ, Mears SC, Lee H (2010) General anesthesia occurs frequently in elderly patients during propofol-based sedation and spinal anesthesia. J Clin Anesth 22:179–183CrossRefPubMed

60.

Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB, Mears SC (2010) Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair [Erratum in Mayo Clin Proc. 2010 Apr;85(4):400]. Mayo Clin Proc 85:18–26CrossRefPubMed

61.

Van den Berghe G, Wilmer A, Milants I, Wouters PJ, Bouckaert B, Bruyninckx F, Bouillon R, Schetz M (2006) Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes 55:3151–3159CrossRefPubMed

62.

Marik PE, Preiser JC (2010) Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis. Chest 137:544–551CrossRefPubMed

63.

Carson JL, Duff A, Berlin JA, Lawrence VA, Poses RM, Huber EC, O’Hara DA, Noveck H, Strom BL (1998) Perioperative blood transfusion and postoperative mortality. JAMA 279:199–205CrossRefPubMed

64.

British Orthopaedic Association (2005) Blood conservation in elective orthopaedic surgery. British Orthopaedic Association, London

65.

Motovska Z, Kala P (2008) Benefits and risks of clopidogrel use in patients with coronary artery disease: evidence from randomized studies and registries. Clin Ther 30:2191–2202CrossRefPubMed

66.

Patti G, Colonna G, Pasceri V, Pepe LL, Montinaro A, Di Sciascio G (2005) Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (antiplatelet therapy for reduction of myocardial damage during angioplasty) study. Circulation 111:2099–2106CrossRefPubMed

67.

Sim W, Gonski PN (2009) The management of patients with hip fractures who are taking clopidogrel. Australas J Ageing 28:194–197CrossRefPubMed

68.

Harty JA, McKenna P, Moloney D, D’Souza L, Masterson E (2007) Anti-platelet agents and surgical delay in elderly patients with hip fractures. J Orthop Surg 15:270–272

69.

Johansen A, White J, Turk A (2008) Clopidogrel therapy—implications for hip fracture surgery. Injury 39:1188–1190CrossRefPubMed

70.

Inman DS, Michla Y, Partington PF (2007) Perioperative management of trauma patients admitted on clopidogrel (Plavix). A survey of orthopaedic departments across the United Kingdom. Injury 38:625–630CrossRefPubMed

71.

Lavelle WF, Demers Lavelle EA, Uhl R (2008) Operative delay for orthopedic patients on clopidogrel (Plavix): a complete lack of consensus. J Trauma 64:996–1000CrossRefPubMed

72.

Palan J, Odutola A, White SP (2007) Is clopidogrel stopped prior to hip fracture surgery—a survey of current practice in the United Kingdom. Injury 38:1279–1285CrossRefPubMed

73.

Al-Rashid M, Parker MJ (2005) Anticoagulation management in hip fracture patients on warfarin. Injury 36:1311–1315CrossRefPubMed

74.

Bansal R, Watson DK (2005) Surgical delay in acute admissions on warfarin: are we doing enough? Int J Clin Pract 59:1283–1288CrossRefPubMed

75.

Crowther MA, Ageno W, Garcia D, Wang L, Witt DM, Clark NP, Blostein MD, Kahn SR, Vesely SK, Schulman S, Kovacs MJ, Rodger MA, Wells P, Anderson D, Ginsberg J, Selby R, Siragusa S, Silingardi M, Dowd MB, Kearon C (2009) Oral vitamin K versus placebo to correct excessive anticoagulation in patients receiving warfarin: a randomized trial. Ann Intern Med 150:293–300PubMed

76.

Crowther MA, Donovan D, Harrison L, McGinnis J, Ginsberg J (1998) Low-dose oral vitamin K reliably reverses over-anticoagulation due to warfarin. Thromb Haemost 79:1116–1118PubMed

77.

Denas G, Marzot F, Offelli P, Stendardo A, Cucchini U, Russo R, Nante G, Iliceto S, Pengo V (2009) Effectiveness and safety of a management protocol to correct over-anticoagulation with oral vitamin K: a retrospective study of 1,043 cases. J Thromb Thrombolysis 27:340–347CrossRefPubMed

78.

Hanslik T, Prinseau J (2004) The use of vitamin K in patients on anticoagulant therapy: a practical guide. Am J Cardiovasc Drugs 4:43–55CrossRefPubMed

79.

O'Shaughnessy DF, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, Yates S, Williamson LM, British Committee for Standards in Haematology BTTF (2004) Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol 126:11–28CrossRefPubMed

80.

Leissinger CA, Blatt PM, Hoots WK, Ewenstein B (2008) Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol 83:137–143CrossRefPubMed

81.

Botella-Carretero JI, Iglesias B, Balsa JA, Arrieta F, Zamarron I, Vazquez C (2010) Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: a randomized clinical trial. Clin Nutr. doi:10.1016/j.clnu.2010.01.012

82.

Botella-Carretero JI, Iglesias B, Balsa JA, Zamarron I, Arrieta F, Vazquez C (2008) Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. JPEN J Parenter Enteral Nutr 32:120–128CrossRefPubMed

83.

Neumann M, Friedmann J, Roy MA, Jensen GL (2004) Provision of high-protein supplement for patients recovering from hip fracture. Nutrition 20:415–419CrossRefPubMed

84.

Olofsson B, Stenvall M, Lundstrom M, Svensson O, Gustafson Y (2007) Malnutrition in hip fracture patients: an intervention study. J Clin Nurs 16:2027–2038CrossRefPubMed

85.

Eneroth M, Olsson UB, Thorngren KG (2006) Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res 451:212–217CrossRefPubMed

86.

Price R, Daly F, Pennington CR, McMurdo MET (2005) Nutritional supplementation of very old people at hospital discharge increases muscle strength: a randomised controlled trial. Gerontology 51:179–185CrossRefPubMed

87.

Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP (1998) Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 128:801–809PubMed

88.

Hommel A, Bjorkelund KB, Thorngren KG, Ulander K (2007) Nutritional status among patients with hip fracture in relation to pressure ulcers. Clin Nutr 26:589–596CrossRefPubMed

89.

Espaulella J, Guyer H, Diaz-Escriu F, Mellado-Navas JA, Castells M, Pladevall M (2000) Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial. Age Ageing 29:425–431CrossRefPubMed

90.

Adams DH, Snedden DP (2006) How misconceptions among elderly patients regarding survival outcomes of inpatient cardiopulmonary resuscitation affect do-not-resuscitate orders. J Am Osteopath Assoc 106:402–404PubMed

91.

Di Bari M, Chiarlone M, Fumagalli S, Boncinelli L, Tarantini F, Ungar A, Marini M, Masotti G, Marchionni N (2000) Cardiopulmonary resuscitation of older, inhospital patients: immediate efficacy and long-term outcome. Crit Care Med 28:2320–2325CrossRefPubMed

92.

Beaupre LA, Cinats JG, Jones CA, Scharfenberger AV, Johnston DWC, Senthilselvan A, Saunders LD (2007) Does functional recovery in elderly hip fracture patients differ between patients admitted from long-term care and the community? J Gerontol A Biol Sci Med Sci 62:1127–1133PubMed

93.

Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 75:797–798PubMed

94.

Kristensen MT, Foss NB, Ekdahl C, Kehlet H (2010) Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop 81:296–302CrossRefPubMed

95.

Foss NB, Kristensen MT, Kehlet H (2006) Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score. Clin Rehabil 20:701–708CrossRefPubMed

96.

Inouye SK, Studenski S, Tinetti ME, Kuchel GA (2007) Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 55:780–791CrossRefPubMed

97.

Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, Roth C, MacLean CH, Shekelle PG, Sloss EM, Wenger NS (2001) The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc 49:1691–1699CrossRefPubMed

98.

Min LC, Elliott MN, Wenger NS, Saliba D (2006) Higher Vulnerable Elders Survey scores predict death and functional decline in vulnerable older people. J Am Geriatr Soc 54:507–511CrossRefPubMed

99.

Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10:20–30PubMed

100.

Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, Silberzweig SB, Siu AL (2007) Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc 55:407–413CrossRefPubMed

Titel: How to optimize patients for geriatric fracture surgery
verfasst von: D. Marsland
P. L. Colvin
S. C. Mears
S. L. Kates
Publikationsdatum: 01.12.2010
Verlag: Springer-Verlag
Erschienen in: Osteoporosis International / Ausgabe Sonderheft 4/2010
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-010-1418-8

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