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Erschienen in: Archives of Orthopaedic and Trauma Surgery 11/2010

01.11.2010 | Orthopaedic Surgery

Medical problems in hip fracture patients

verfasst von: Carol Pei Wei Chong, Judith A. Savige, Wen Kwang Lim

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 11/2010

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Abstract

Increasing number of older patients are admitted to hospital with hip fractures. This review evaluates the common medical problems that arise as a consequence of having a hip fracture. Older patients with fractures commonly have co-morbidities that require evaluation prior to and after surgery. Joint acute orthopaedic–geriatric units have been established to provide comprehensive orthopaedic and medical care with some studies showing a reduction in postoperative complications and mortality. Recommendations surrounding the care of the older orthopaedic patient include early surgical fixation, the use of prophylactic antibiotics and thromboembolic prophylaxis, good perioperative pain control to improve ambulation, delirium detection and management to decrease the risk complications, such as institutionalisation, the avoidance of malnutrition, urinary tract management, osteoporosis management and the promotion of early mobilisation to improve functional recovery. Physicians are well placed to manage these patients with orthopaedic surgeons during the perioperative period. Sufficient evidence exists for most recommendations for fracture patients, but further research is needed in most areas.
Literatur
1.
Zurück zum Zitat Khan R, Fernandez C, Kashifl F, Shedden R, Diggory P (2002) Combined orthogeriatric care in the management of hip fractures: a prospective study. Ann R Coll Surg Engl 84(2):122–124PubMed Khan R, Fernandez C, Kashifl F, Shedden R, Diggory P (2002) Combined orthogeriatric care in the management of hip fractures: a prospective study. Ann R Coll Surg Engl 84(2):122–124PubMed
2.
Zurück zum Zitat Shyu Y-IL, Liang J, Wu C-C, Su J-Y, Cheng H-S, Chou S-W et al (2005) A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc 53(5):811–818CrossRefPubMed Shyu Y-IL, Liang J, Wu C-C, Su J-Y, Cheng H-S, Chou S-W et al (2005) A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc 53(5):811–818CrossRefPubMed
4.
Zurück zum Zitat Sainsbury R, Gillespie WJ, Armour PC, Newman EF (1986) An orthopaedic geriatric rehabilitation unit: the first two years experience. N Z Med J 99(807):583–585PubMed Sainsbury R, Gillespie WJ, Armour PC, Newman EF (1986) An orthopaedic geriatric rehabilitation unit: the first two years experience. N Z Med J 99(807):583–585PubMed
5.
Zurück zum Zitat 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. Br Med J 331:1374–1376CrossRef 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. Br Med J 331:1374–1376CrossRef
6.
Zurück zum Zitat Perez JV, Warwick CP, Case CP, Bannister GC (1995) Death after proximal femoral fracture—an autopsy study. Injury 26(4):237–240CrossRefPubMed Perez JV, Warwick CP, Case CP, Bannister GC (1995) Death after proximal femoral fracture—an autopsy study. Injury 26(4):237–240CrossRefPubMed
7.
Zurück zum Zitat Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53(9):1476–1482 (see comment)CrossRefPubMed Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53(9):1476–1482 (see comment)CrossRefPubMed
8.
Zurück zum Zitat Naglie G, Tansey C, Kirkland JL, Ogilvie-Harris DJ, Detsky AS, Etchells E et al (2002) Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial. Can Med Assoc J 167(1):25–32 Naglie G, Tansey C, Kirkland JL, Ogilvie-Harris DJ, Detsky AS, Etchells E et al (2002) Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial. Can Med Assoc J 167(1):25–32
9.
Zurück zum Zitat Antonelli Incalzi R, Gemma A, Capparella O, Bernabei R, Sanguinetti C, Carbonin PU (1993) Continuous geriatric care in orthopedic wards: a valuable alternative to orthogeriatric units. Aging (Milano) 5(3):207–216 Antonelli Incalzi R, Gemma A, Capparella O, Bernabei R, Sanguinetti C, Carbonin PU (1993) Continuous geriatric care in orthopedic wards: a valuable alternative to orthogeriatric units. Aging (Milano) 5(3):207–216
10.
Zurück zum Zitat Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Budge MM (2006) Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma 20(3):172–178 (discussion 9–80)CrossRefPubMed Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Budge MM (2006) Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma 20(3):172–178 (discussion 9–80)CrossRefPubMed
11.
Zurück zum Zitat Swanson CE, Day GA, Yelland CE, Broome JR, Massey L, Richardson HR et al (1998) The management of elderly patients with femoral fractures: a randomised controlled trial of early intervention versus standard care. MJA 169:515–518PubMed Swanson CE, Day GA, Yelland CE, Broome JR, Massey L, Richardson HR et al (1998) The management of elderly patients with femoral fractures: a randomised controlled trial of early intervention versus standard care. MJA 169:515–518PubMed
12.
Zurück zum Zitat Chong C, Christou J, Fitzpatrick K, Wee R, Lim WK (2008) Description of an orthopedic–geriatric model of care in Australia with 3 years data. Geriatr Gerontol Int 8:86–92CrossRefPubMed Chong C, Christou J, Fitzpatrick K, Wee R, Lim WK (2008) Description of an orthopedic–geriatric model of care in Australia with 3 years data. Geriatr Gerontol Int 8:86–92CrossRefPubMed
13.
Zurück zum Zitat Morrison RS, Chassin MR, Siu AL (1998) The Medical consultant’s role in caring for patients with hip fracture. Ann Intern Med 128:1010–1020PubMed Morrison RS, Chassin MR, Siu AL (1998) The Medical consultant’s role in caring for patients with hip fracture. Ann Intern Med 128:1010–1020PubMed
14.
Zurück zum Zitat Beaupre LA, Jones CA, Saunders LD, Johnston DWC, Buckingham J, Majumdar SR (2005) Best practices for elderly hip fracture patients: a systematic overview of the evidence. J Gen Intern Med 20(11):1019–1025CrossRefPubMed Beaupre LA, Jones CA, Saunders LD, Johnston DWC, Buckingham J, Majumdar SR (2005) Best practices for elderly hip fracture patients: a systematic overview of the evidence. J Gen Intern Med 20(11):1019–1025CrossRefPubMed
15.
Zurück zum Zitat Kagaya H, Shimada Y (2007) Treatment and rehabilitation after hip fracture in the elderly. Crit Rev Phys Rehabil Med 19(2):97–113CrossRef Kagaya H, Shimada Y (2007) Treatment and rehabilitation after hip fracture in the elderly. Crit Rev Phys Rehabil Med 19(2):97–113CrossRef
16.
Zurück zum Zitat 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(9):702–709CrossRefPubMed 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(9):702–709CrossRefPubMed
17.
Zurück zum Zitat Jain R, Basinki A, Kreder HJ (2003) Nonoperative treatment of hip fractures. Int Orthop 27:11–17PubMed Jain R, Basinki A, Kreder HJ (2003) Nonoperative treatment of hip fractures. Int Orthop 27:11–17PubMed
18.
Zurück zum Zitat Parker MJ, Handoll HHG, Bhargava A (2000) Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev (4):CD000337. doi:10.1002/14651858.CD000337 Parker MJ, Handoll HHG, Bhargava A (2000) Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev (4):CD000337. doi:10.​1002/​14651858.​CD000337
19.
Zurück zum Zitat Parker MJ, Gurusamy KS (2006) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 3:CD001706 Parker MJ, Gurusamy KS (2006) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 3:CD001706
20.
Zurück zum Zitat Borris LC (2009) Barriers to the optimal use of anticoagulants after orthopaedic surgery. Arch Orthop Trauma Surg 129:1441–1445CrossRefPubMed Borris LC (2009) Barriers to the optimal use of anticoagulants after orthopaedic surgery. Arch Orthop Trauma Surg 129:1441–1445CrossRefPubMed
21.
Zurück zum Zitat Collins R, Scrimgeour A, Yusuf S, Peto R (1988) Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin: overview of results of randomized trials in general, orthopaedic, and urologic surgery. N Engl J Med 318:1162–1173CrossRefPubMed Collins R, Scrimgeour A, Yusuf S, Peto R (1988) Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin: overview of results of randomized trials in general, orthopaedic, and urologic surgery. N Engl J Med 318:1162–1173CrossRefPubMed
22.
Zurück zum Zitat Handoll HHG, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ (2002) Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev 4:CD000305. doi:10.1002/14651858.CD000305 Handoll HHG, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ (2002) Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev 4:CD000305. doi:10.​1002/​14651858.​CD000305
23.
Zurück zum Zitat Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR et al (2008) Prevention of venous thromboembolism. Chest 133:381S–453SCrossRefPubMed Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR et al (2008) Prevention of venous thromboembolism. Chest 133:381S–453SCrossRefPubMed
24.
Zurück zum Zitat Eriksson BI, Lassen MR (2003) Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med 163(11):1337–1342CrossRefPubMed Eriksson BI, Lassen MR (2003) Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med 163(11):1337–1342CrossRefPubMed
25.
Zurück zum Zitat Hofman A, Geelkerken RH, Wille J, Hamming JJ, Breslau PJ, Geelkerken RH et al (1994) Pressure sores and pressure-decreasing mattresses: controlled clinical trial. Lancet 343(8897):568–571CrossRefPubMed Hofman A, Geelkerken RH, Wille J, Hamming JJ, Breslau PJ, Geelkerken RH et al (1994) Pressure sores and pressure-decreasing mattresses: controlled clinical trial. Lancet 343(8897):568–571CrossRefPubMed
26.
Zurück zum Zitat Morrison RS, Magaziner J, McLaughlin MA, Orosz G, Silberzweig SB, Koval KJ et al (2003) The impact of post-operative pain on outcomes following hip fracture. Pain 103(3):303–311CrossRefPubMed Morrison RS, Magaziner J, McLaughlin MA, Orosz G, Silberzweig SB, Koval KJ et al (2003) The impact of post-operative pain on outcomes following hip fracture. Pain 103(3):303–311CrossRefPubMed
27.
Zurück zum Zitat Toms AD, Mandalia V, Haigh R, Hopwood B (2009) The management of patients with painful total knee replacement. J Bone Joint Surg 91B(2):143–150 (British Volume) Toms AD, Mandalia V, Haigh R, Hopwood B (2009) The management of patients with painful total knee replacement. J Bone Joint Surg 91B(2):143–150 (British Volume)
28.
Zurück zum Zitat Parker MJ, Griffiths R, Appadu BN (2002) Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev 1:CD001159 Parker MJ, Griffiths R, Appadu BN (2002) Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev 1:CD001159
29.
Zurück zum Zitat Fletcher AK, Rigby AS, Heyes FL (2003) Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized controlled trial. Ann Emerg Med 41(2):227–233CrossRefPubMed Fletcher AK, Rigby AS, Heyes FL (2003) Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized controlled trial. Ann Emerg Med 41(2):227–233CrossRefPubMed
30.
Zurück zum Zitat Scheinin H, Virtanen T, Kentala E, Uotila P, Laitio T, Hartiala J et al (2000) Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischaemia in elderly patients with hip fracture: a randomized controlled trial. Acta Anaesthesiol Scand 44(9):1061–1070CrossRefPubMed Scheinin H, Virtanen T, Kentala E, Uotila P, Laitio T, Hartiala J et al (2000) Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischaemia in elderly patients with hip fracture: a randomized controlled trial. Acta Anaesthesiol Scand 44(9):1061–1070CrossRefPubMed
31.
Zurück zum Zitat Matot I, Oppenheim-Eden A, Ratrot R, Baranova J, Davidson E, Eylon S et al (2003) Preoperative cardiac events in elderly patients with hip fracture randomized to epidural or conventional analgesia. Anesthesiology 98:156–163CrossRefPubMed Matot I, Oppenheim-Eden A, Ratrot R, Baranova J, Davidson E, Eylon S et al (2003) Preoperative cardiac events in elderly patients with hip fracture randomized to epidural or conventional analgesia. Anesthesiology 98:156–163CrossRefPubMed
32.
Zurück zum Zitat Gustafson Y, Berggren D, Brannstrom B, Bucht G, Norberg A, Hansson LI, et al (1988) Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc 36(6):525–530 Gustafson Y, Berggren D, Brannstrom B, Bucht G, Norberg A, Hansson LI, et al (1988) Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc 36(6):525–530
33.
Zurück zum Zitat Williams MA, Campbell EB, Raynor WJ, Mlynarczyk SM, Ward SE (1985) Reducing acute confusional states in elderly patients with hip fracture. Res Nurs Health 39:329–337 Williams MA, Campbell EB, Raynor WJ, Mlynarczyk SM, Ward SE (1985) Reducing acute confusional states in elderly patients with hip fracture. Res Nurs Health 39:329–337
34.
Zurück zum Zitat Gustafson Y, Brannstrom B, Berggren D, Ragnarsson JI, Siggard J, Bucht G et al (1991) A geriatric–anaesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J Am Geriatr Soc 39:655–662PubMed Gustafson Y, Brannstrom B, Berggren D, Ragnarsson JI, Siggard J, Bucht G et al (1991) A geriatric–anaesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J Am Geriatr Soc 39:655–662PubMed
35.
36.
Zurück zum Zitat Michelson JD, Lotke PA, Steinberg ME (1988) Urinary-bladder management after total joint-replacement surgery. N Engl J Med 319:321–326CrossRefPubMed Michelson JD, Lotke PA, Steinberg ME (1988) Urinary-bladder management after total joint-replacement surgery. N Engl J Med 319:321–326CrossRefPubMed
37.
Zurück zum Zitat Skelly JM, Guyatt GH, Kalbfleisch R, Singer J, Winter L (1992) Management of urinary retention after surgical repair of hip fracture. Can Med Assoc J 146(7):1185–1189 Skelly JM, Guyatt GH, Kalbfleisch R, Singer J, Winter L (1992) Management of urinary retention after surgical repair of hip fracture. Can Med Assoc J 146(7):1185–1189
38.
Zurück zum Zitat Shabat S (2005) Hip fractures in elderly patients: perspectives towards the future. Disabil Rehabil 27(18–19):1039–1040CrossRefPubMed Shabat S (2005) Hip fractures in elderly patients: perspectives towards the future. Disabil Rehabil 27(18–19):1039–1040CrossRefPubMed
39.
Zurück zum Zitat Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357(18):1799–1809 Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357(18):1799–1809
40.
Zurück zum Zitat Eriksen EF, Lyles KW, Colon-Emeric CS, Pieper CF, Magaziner JS, Adachi JD et al (2009) Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Miner Res 24(7):1308–1313CrossRefPubMed Eriksen EF, Lyles KW, Colon-Emeric CS, Pieper CF, Magaziner JS, Adachi JD et al (2009) Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Miner Res 24(7):1308–1313CrossRefPubMed
41.
Zurück zum Zitat Demontiero O, Duque G (2009) Once-yearly zoledronic acid in hip fracture prevention. Clin Interv Aging 4(1):153–164 Demontiero O, Duque G (2009) Once-yearly zoledronic acid in hip fracture prevention. Clin Interv Aging 4(1):153–164
42.
Zurück zum Zitat Cummings SR, Joseph Melton L III (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(359):1761–1767CrossRefPubMed Cummings SR, Joseph Melton L III (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(359):1761–1767CrossRefPubMed
43.
Zurück zum Zitat Ceder L (2005) Predicting the success of rehabilitation following hip fractures. Disabil Rehabil 27(18–19):1073–1080CrossRefPubMed Ceder L (2005) Predicting the success of rehabilitation following hip fractures. Disabil Rehabil 27(18–19):1073–1080CrossRefPubMed
Metadaten
Titel
Medical problems in hip fracture patients
verfasst von
Carol Pei Wei Chong
Judith A. Savige
Wen Kwang Lim
Publikationsdatum
01.11.2010
Verlag
Springer-Verlag
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 11/2010
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-009-1038-y

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