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Chapter 34 - Musculoskeletal injuries in the elderly

from Section III - Care of the elderly by organ system

Published online by Cambridge University Press:  05 June 2016

By
Natalie R. Danna  and
Joseph D. Zuckerman
Edited by
Jan Busby-Whitehead ,
Christine Arenson ,
Samuel C. Durso ,
Daniel Swagerty ,
Laura Mosqueda ,
Maria Fiatarone Singh  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Samuel C. Durso
Affiliation:
The Johns Hopkins University School of Medicine
Daniel Swagerty
Affiliation:
University of Kansas
Laura Mosqueda
Affiliation:
University of Southern California
Maria Fiatarone Singh
Affiliation:
University of Sydney
William Reichel
Affiliation:
Georgetown University, Washington DC
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Summary

Orthopaedic trauma in the elderly patient presents both a medical and a surgical challenge. This growing population requires injury management tailored to specific patient needs. The more common musculoskeletal injuries encountered in the elderly include proximal humerus fractures, wrist fractures, hip fractures, ankle fractures, and vertebral compression fractures. Injury treatment is based on patient factors, injury factors, and other special considerations in order to optimize outcome. The goal of injury treatment in the elderly patient is enabling return to pre-injury functional status.
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 462 - 476
Publisher: Cambridge University Press
Print publication year: 2016

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References

Owens, W.D., Felts, J.A., and Spitznagel, E.L. Jr., ASA physical status classifications: a study of consistency of ratings. Anesthesiology, 1978. 49(4): 239–43.Google Scholar
Bloem, B.R., Grimbergen, Y.A., Cramer, M., et al., Prospective assessment of falls in Parkinson’s disease. J Neurol, 2001. 248(11): 950–8.CrossRefGoogle ScholarPubMed
McClure, J. and Goldsborough, S., Fractured neck of femur and contralateral intracerebral lesions. J Clin Pathol, 1986. 39(8): 920–2.Google Scholar
Soto-Hall, R., Treatment of transcervical fractures complicated by certain common neurological conditions. In: Instructional Course Lectures XVII, Reynolds, F.C., Editor. 1960, St. Louis: CV Mosby; 117–120.Google Scholar
Loder, R.T., The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res, 1988(232): 210–6.CrossRefGoogle Scholar
Ganesh, SP, Pietrobon, R., Cecilio, W.A., et al., The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am, 2005. 87(8): 1712–8.Google Scholar
Ahmed, LA, Joakimsen, R.M., Berntsen, G.K., et al., Diabetes mellitus and the risk of non-vertebral fractures: the Tromso study. Osteoporos Int, 2006. 17(4): 495–500.Google Scholar
Egol, K.A., Tejwani, N.C., Walsh, M.G., et al., Predictors of short-term functional outcome following ankle fracture surgery. J Bone Joint Surg Am, 2006. 88(5):974–9.CrossRefGoogle ScholarPubMed
Lane, J.M. and Vigorita, V.J., Osteoporosis. J Bone Joint Surg Am, 1983. 65(2):274–8.CrossRefGoogle ScholarPubMed
Fulkerson, E., Egol, K.A., Kubiak, E.N., et al., Fixation of diaphyseal fractures with a segmental defect: a biomechanical comparison of locked and conventional plating techniques. J Trauma, 2006. 60(4):830–5.Google Scholar
Bhutani, G. and Gupta, M.C., Emerging therapies for the treatment of osteoporosis. J Midlife Health. 4(3): 147–152.Google Scholar
Sammartino, A., Cirillo, D., Mandato, V.D., et al., Osteoporosis and cardiovascular disease: benefit-risk of hormone replacement therapy. J Endocrinol Invest, 2005. 28(10 Suppl):80–4.Google Scholar
Gass, M. and Dawson-Hughes, B., Preventing osteoporosis-related fractures: an overview. Am J Med, 2006. 119(4 Suppl 1):S3–S11.Google Scholar
Kalu, D.N. and Masoro, E.J., The biology of aging, with particular reference to the musculoskeletal system. Clin Geriatr Med, 1988. 4(2):257–67.CrossRefGoogle ScholarPubMed
Tomonaga, M., Histochemical and ultrastructural changes in senile human skeletal muscle. J Am Geriatr Soc, 1977. 25(3):125–31.Google Scholar
McCarter, R., Effects of age on contraction of mammalian skeletal muscle. In: Aging in muscle, Kalkor, J. D. G., Editor. 1978, New York: Raven Press; 1–22.Google Scholar
Murray, M.P., Duthie, E.H. Jr., Gmbert, S.R., et al., Age-related differences in knee muscle strength in normal women. J Gerontol, 1985. 40(3):275–80.Google Scholar
Broos, P.L., Stappaerts, K.H., Rommens, P.M., et al., Polytrauma in patients of 65 and over: injury patterns and outcome. Int Surg, 1988. 73(2): 119–22.Google Scholar
Martin, R.E. and Teberian, G., Multiple trauma and the elderly patient. Emerg Med Clin North Am, 1990. 8(2):411–20.Google Scholar
DeMaria, E.J., Kenney, P.R., Merriam, M.A., et al., Survival after trauma in geriatric patients. Ann Surg, 1987. 206(6):738–43.Google Scholar
Horst, H.M., Obeid, F.n., Sorensen, V.J., and Biins, B.A., Factors influencing survival of elderly trauma patients. Crit Care Med, 1986. 14(8):681–4.Google Scholar
Oreskovich, M.R., Howard, J.D., Copass, M.K., and Carrocp, C.J., Geriatric trauma: injury patterns and outcome. J Trauma, 1984. 24(7):565–72.CrossRefGoogle ScholarPubMed
Bone, L. and Bucholz, R., The management of fractures in the patient with multiple trauma. J Bone Joint Surg Am, 1986. 68(6):945–9.Google Scholar
Gustilo, R.B. and Anderson, J.T., Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am, 1976. 58(4):453–8.CrossRefGoogle ScholarPubMed
Gustilo, R.B., Simpson, L., Nixon, R., et al., Analysis of 511 open fractures. Clin Orthop Relat Res, 1969. 66:148–54.CrossRefGoogle ScholarPubMed
Cornell, C.N., Lane, J.M., and Poynton, A.R., Orthopedic management of vertebral and long bone fractures in patients with osteoporosis. Clin Geriatr Med, 2003. 19(2):433–55.Google Scholar
Salter, R.B., Simmonds, D.F., Malcolm, B.W., et al., The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am, 1980. 62(8): 1232–51.Google Scholar
Scott, R.D., Turner, R.H., Leitzes, S.M., and Aufranc, O.E., Femoral fractures in conjunction with total hip replacement. J Bone Joint Surg Am, 1975. 57(4):494–501.Google Scholar
Zickel, R.E., Fietti, V.G. Jr., Lawsing, J.F., and Cochran, G.V., A new intramedullary fixation device for the distal third of the femur. Clin Orthop Relat Res, 1977. 125: 185–91.Google Scholar
Johansson, J.E., McBroom, R., Barrington, T.W., and Hunter, G.A., Fracture of the ipsilateral femur in patients wih total hip replacement. J Bone Joint Surg Am, 1981. 63(9):1435–42.Google Scholar
Clain, A., Secondary Malignant Disease of Bone. Br J Cancer, 1965. 19:15–29.Google Scholar
Jaffe, H., Tumors and Tumorous Conditions of Bones and Joint. 1958, Philadelphia: Lea & Febiger.Google Scholar
Parrish, F.F. and Murray, J.A., Surgical treatment for secondary neoplastic fractures. A retrospective study of ninety-six patients. J Bone Joint Surg Am, 1970. 52(4): 665–86.Google Scholar
Harrington, K., Impending pathologic fractures from metastatic malignancy: Evaluation and management. In: American Academy of Orthopaedic Surgeons Instructional Course Lectures XXXV, Anderson, L., Editor. 1986, St. Louis: CV Mosby; 357–381.Google Scholar
Harrington, K.D., Sim, F.H., Enis, J.E., et al., Methylmethacrylate as an adjunct in internal fixation of pathological fractures. Experience with three hundred and seventy-five cases. J Bone Joint Surg Am, 1976. 58(8): 1047–55.Google Scholar
Papapetrou, P.D., Bisphosphonate-associated adverse events. Hormones (Athens), 2009. 8(2): 96–110.Google Scholar
Neviaser, A.S., Lane, J.M., Lenart, B.A., et al., Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma, 2008. 22(5): 346–50.Google Scholar
Odvina, C.V., Zerwekh, J.E., Rao, D.S., et al., Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab, 2005. 90(3): 1294–301.Google Scholar
Thompson, R.N., Phillips, J.R., McCauley, S.H., et al., Atypical femoral fractures and bisphosphonate treatment: experience in two large United Kingdom teaching hospitals. J Bone Joint Surg Br, 2012. 94(3): 385–90.Google ScholarPubMed
Shane, E., Burr, D., Ebeling, P.R., et al., Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res, 1987. 29(1): 1–23.Google Scholar
Ha, Y.C., Cho, M.R., Park, K.H., et al., Is surgery necessary for femoral insufficiency fractures after long-term bisphosphonate therapy? Clin Orthop Relat Res, 2010. 468(12): 3393–8.Google Scholar
Egol, K.A., Park, J.H., Prensky, C., et al., Surgical treatment improves clinical and functional outcomes for patients who sustain incomplete bisphosphonate-related femur fractures. J Orthop Trauma, 2013. 27(6): 331–5.Google Scholar
Banffy, M.B., Vrahas, M.S., Ready, J.E., and Abraham, J.A., Nonoperative versus prophylactic treatment of bisphosphonate-associated femoral stress fractures. Clin Orthop Relat Res. 469(7): 2028–34.Google Scholar
Sexson, S.B. and Lehner, J.T., Factors affecting hip fracture mortality. J Orthop Trauma, 1987. 1(4):298–305.CrossRefGoogle ScholarPubMed
Kenzora, J.E., McCarthy, R.E., Lowell, J.D., and Sledge, C.B., Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res, 1984(186): 45–56.Google Scholar
Zuckerman, J.D., Skovron, M.L., Koval, K.J., et al., Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am, 1995. 77(10):1551–6.Google Scholar
Davis, F.M., Woolner, D.F., Frampton, C., et al., Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth, 1987. 59(9):1080–8.Google Scholar
Valentin, N., Lomholt, B., Jensen, J.S., et al., Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. Br J Anaesth, 1986. 58(3):284–91.Google Scholar
Modig, J., Borg, T., Karlstrom, G., et al., Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg, 1983. 62(2):174–80.Google Scholar
Brody, J.A., Prospects for an ageing population. Nature, 1985. 315(6019):463–6.Google Scholar
Frandsen, P.A. and Kruse, T., Hip fractures in the county of Funen, Denmark. Implications of demographic aging and changes in incidence rates. Acta Orthop Scand, 1983. 54(5):681–6.Google Scholar
Praemer, A., Furner, S., and Rice, D.P., Musculoskeletal Conditions in the United States. 1992, Park Ridge, IL: American Academy of Orthopaedic Surgeons; vii, 199.Google Scholar
Greenspan, S.L., Myers, S.L., Maitland, L.A., et al., Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA, 1994. 271(2):128–33.Google Scholar
Hinton, R.Y. and Smith, G.S., The association of age, race, and sex with the location of proximal femoral fractures in the elderly. J Bone Joint Surg Am, 1993. 75(5):752–9.Google Scholar
Hinton, R.Y., Lennox, D.W., Ebert, F.R., et al., Relative rates of fracture of the hip in the United States. Geographic, sex, and age variations. J Bone Joint Surg Am, 1995. 77(5):695–702.Google Scholar
Garraway, W.M., Stauffer, R.N., Kurland, L.T., and O’Fallon, W.M., Limb fractures in a defined population. II. Orthopedic treatment and utilization of health care. Mayo Clin Proc, 1979. 54(11): 708–13.Google Scholar
Johnell, O. and Sernbo, I., Health and social status in patients with hip fractures and controls. Age Ageing, 1986. 15(5):285–91.Google Scholar
Uden, G. and Nilsson, B., Hip fracture frequent in hospital. Acta Orthop Scand, 1986. 57(5):428–30.Google Scholar
Rizzo, P.F., Gould, E.S., Lynden, J.P., and Asnis, S.E., Diagnosis of occult fractures about the hip. Magnetic resonance imaging compared with bone-scanning. J Bone Joint Surg Am, 1993. 75(3): 395–401.CrossRefGoogle ScholarPubMed
Parker, M.J., Myles, J.W., CAnandramer, J.K., and Drewett, R., Cost-benefit analysis of hip fracture treatment. J Bone Joint Surg Br, 1992. 74(2):261–4.Google Scholar
Colwell, C.W. Jr., Spiro, T.E., Trowbridge, A.A., et al., Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement. A clinical trial comparing efficacy and safety. Enoxaparin Clinical Trial Group. J Bone Joint Surg Am, 1994. 76(1):3–14.Google Scholar
Geerts, W.H., Jay, R.M., Code, K.I., et al., A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med, 1996. 335(10):701–7.Google Scholar
Merli, G.J., Update. Deep vein thrombosis and pulmonary embolism prophylaxis in orthopedic surgery. Med Clin North Am, 1993. 77(2): 397–411.Google Scholar
Kinov, P., Tanchev, P.P., Ellis, M., and Volpin, G., Antithrombotic prophylaxis in major orthopaedic surgery: an historical overview and update of current recommendations. Int Orthop. 38(1): 169–75.Google Scholar
Koval, K.J., Skovron, M.L., Aharanoff, G.B., et al., Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res, 1995. 310: 150–9.Google Scholar
White, B.L., Fisher, W.D., and Laurin, C.A., Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg Am, 1987. 69(9):1335–40.Google Scholar
Tajeu, G.S., Delzell, E., Smith, W., et al., Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci, 2014. 69(3): 346–53.Google Scholar
Aharonoff, G.B., Koval, K.J., Skovron, M.L., and Zuckerman, J.D., Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma, 1997. 11(3):162–5.CrossRefGoogle ScholarPubMed
Seitz, D.P., Anderson, G.M., Austin, P.C., et al., Effects of impairment in activities of daily living on predicting mortality following hip fracture surgery in studies using administrative healthcare databases. BMC Geriatr. 14(1): 9.Google Scholar
Koval, K.J., Friend, K.D., Aharonoff, G.B., and Zuckerman, J.D., Weight bearing after hip fracture: a prospective series of 596 geriatric hip fracture patients. J Orthop Trauma, 1996. 10(8):526–30.Google ScholarPubMed
Koval, K.J., Sala, D.A., Kummer, F.J., and Zuckerman, J.D., Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. J Bone Joint Surg Am, 1998. 80(3):352–6.Google Scholar
Probe, R. and Ward, R., Internal fixation of femoral neck fractures. J Am Acad Orthop Surg, 2006. 14(9):565–71.Google Scholar
Schmidt, A.H. and Swiontkowski, M.F., Femoral neck fractures. Orthop Clin North Am, 2002. 33(1): 97–111, viii.Google Scholar
Cobb, A.G. and Gibson, P.H., Screw fixation of subcapital fractures of the femur – a better method of treatment? Injury, 1986. 17(4): 259–64.Google Scholar
Garden, R.S., Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br, 1971. 53(2):183–97.Google Scholar
Stromqvist, B., Hansson, L.I., Nilsson, L.T., and Thorngren, K.G., Hook-pin fixation in femoral neck fractures. A two-year follow-up study of 300 cases. Clin Orthop Relat Res, 1987(218): 58–62.Google Scholar
Bentley, G., Treatment of nondisplaced fractures of the femoral neck. Clin Orthop Relat Res, 1980(152): 93–101.Google Scholar
Calder, S.J., Anderson, G.H., Jagger, C., et al., Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study. J Bone Joint Surg Br, 1996. 78(3):391–4.Google Scholar
Keating, J.F., Grant, A., Masson, M., et al., Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty: treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am, 2006. 88(2):249–60.Google Scholar
Hardy, D.C., Descamps, P.Y., Krallis, P., et al., Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am, 1998. 80(5):618–30.Google Scholar
Adams, C.I., Robinson, C.M., Court-Brown, C.M., and McQueen, M.M., Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma, 2001. 15(6):394–400.CrossRefGoogle ScholarPubMed
Crawford, C.H., Malkani, A.L., Cordray, S., et al., The trochanteric nail versus the sliding hip screw for intertrochanteric hip fractures: a review of 93 cases. J Trauma, 2006. 60(2): 325–8; discussion 328–9.Google Scholar
Stiell, I.G., McKnight, R.D., Greenberg, G.H., et al., Implementation of the Ottawa ankle rules. JAMA, 1994. 271(11):827–32.Google Scholar
McConnell, T., Creevy, W., and Tornetta, P. 3rd, Stress examination of supination external rotation-type fibular fractures. J Bone Joint Surg Am, 2004. 86-A(10): 2171–8.CrossRefGoogle ScholarPubMed
Ramsey, P.L. and Hamilton, W., Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am, 1976. 58(3):356–7.Google Scholar
Beauchamp, C.G., Clay, N.R., and Thexton, P.W., Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg Br, 1983. 65(3):329–32.Google Scholar
Ali, M.S., McLaren, C.A.N., Rouholamin, E., and O’Connor, B.T., Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma, 1987. 1(4):275–80.Google Scholar
Neer, C.S. 2nd, Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am, 1970. 52(6): 1090–103.Google Scholar
Neer, C.S. 2nd, Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am, 1970. 52(6): 1077–89.Google Scholar
Alffram, P.A. and Bauer, G.C., Epidemiology of fractures of the forearm: a biomechanical investigation of bone strength. J Bone Joint Surg Am, 1962. 44-A: 105–14.Google Scholar
Rozental, T.D. and Blazar, P.E., Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am, 2006. 31(3):359–65.Google Scholar
Young, B.T. and Rayan, G.M., Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am, 2000. 25(1):19–28.CrossRefGoogle ScholarPubMed
Majd, M.E., Farley, S., and Holt, R.T., Preliminary outcomes and efficacy of the first 360 consecutive kyphoplasties for the treatment of painful osteoporotic vertebral compression fractures. Spine J, 2005. 5(3):244–55.Google Scholar
Prather, H., Van Dillen, L., Metzler, J.P., et al., Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty. J Bone Joint Surg Am, 2006. 88(2):334–41.Google Scholar
Ma, X.L., Xing, D., Ma, J.X., et al., Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis. Eur Spine J. 21(9): 1844–59.Google Scholar

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