Hip Fractures in Older Men

Geriatric Intertrochanteric Fractures: What Is the Optimal Follow-Up Period?

OBJECTIVE

Evaluate patients with intertrochanteric fractures who were treated operatively to determine optimal follow-up to ensure complete fracture healing and recognize complications.

DESIGN

Retrospective review.

SETTING

Academic Level 1 trauma center.

PATIENTS/PARTICIPANTS

Inclusion criteria included isolated intertroch fractures (not pathologic) and complete radiographic and clinical data, with at least 1-year follow-up. Four hundred ninety-seven patients were identified. Two hundred forty-nine patients met inclusion criteria with 194 patients studied.

INTERVENTION

Operative fixation with either CMN or SHS.

MAIN OUTCOME MEASUREMENTS

Radiographic parameters included time to union, neck-shaft angle, tip apex distance, and femoral neck screw telescoping (shortening) for both CMS and SHS combined. Postoperative complications were recorded.

RESULTS

Union was achieved at a mean of 64.8 ± 30.7 days. Mortality (n = 12), infection (n = 4), and implant failure (n = 5) occurred within 3 months. Neck-shaft angle was changed before 3 months. Significant neck shortening for both CMN and SHS occurred within 6 weeks ( P =<0.001). Major complications occurred early, within 3 months.

CONCLUSIONS

Most fractures healed by 3 months and the remainder by 6 months. Routine follow-up for 6 months is more than sufficient for most of these fractures.

LEVEL OF EVIDENCE

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Innovations in Care of the Elderly Hip Fracture Patient; a Nightmare No More

Hip fractures that occur in the elderly population continue to be a growing problem in communities. In this particular population, people 65 years and older, patients often have multiple comorbidities. These comorbidities cause challenges for a patient's optimization preoperatively and throughout the continuum of care. Although unplanned and traumatic, hip fracture patients can benefit from care organized in a comprehensive and standardized way. Having a hip fracture program that is driven by a multidisciplinary team approach has proved to decrease length of stay and promote positive outcomes for patients.

[Selection principles and application status of surgical methods for hip fracture in the elderly]

Objective

To summarize the selection criteria and clinical application of surgical methods for hip fractures (femoral neck fracture and intertrochanteric fracture) in the elderly.

Methods

The related literature concerning the surgical methods for femoral neck fracture and intertrochanteric fracture in the elderly at home and abroad was extensively reviewed and summarized.

Results

Among the elderly patients with femoral neck fracture, the closed reduction and internal fixation or dynamic hip screw (DHS), and total hip arthroplasty are recommended for patients under 65 years old and 65-80 years old respectively and without special surgical contraindication; whereas hemiarthroplasty is recommended for patients with poor physical conditions. Among the patients with intertrochanteric fracture, DHS or the 3rd generation of Gamma nails is recommended for patients with stable fracture while the intramedullary fixation systems (e.g., proximal femoral nail anti-rotation, intertrochanteric antegrade nail) and the extramedullary fixation systems (e.g., proximal femoral locking compression plate and less invasive stabilization system) can be applied to the patients with unstable fracture according to the fracture type and bone conditions. Notably, hip arthroplasty is recommended for elderly patients with comminuted fracture.

Conclusion

The surgical method and internal fixator should be chosen according to the fracture type and bone condition in the elderly in order to improve the effectiveness and reduce the complication.