Functional Outcomes After Nonoperative Management in Older Adult Low-Energy Stable and Unstable Ankle Fractures: A Retrospective Review of 158 Patients.

Background: There is ongoing debate regarding the optimal management of older adult ankle fractures. The purpose of this study was to describe baseline characteristics and functional outcomes including complications in older adult patients receiving nonoperative treatment for low-energy ankle fracture and compare the outcomes of those with unstable vs stable fracture patterns.

Methods: Patients aged ≥65 from January 2012 to March 2019 that sustained an ankle fracture were identified.

Hip Fracture Patterns, Hospital Course, and Mortality Differ Between Males and Females.

Introduction: The purpose of this study was to describe how hip fractures differentially affect male and female patients regarding fracture pattern, hospital course, and postoperative course.

Materials And Methods: This retrospective case series was performed in a metropolitan healthcare system involving 2996 hip fracture patients >59 years old who underwent surgical management (eg, intramedullary nail, hemiarthroplasty, percutaneous pinning, etc.).

Iatrogenic open humeral shaft fractures following functional bracing.

Introduction: The treatment of closed humeral shaft fractures tends to be successful with functional bracing. Treatment failure due to iatrogenic conversion to an open fracture has not been described in the literature. We present a case series of patients that experienced open humeral shaft fractures after initially being treated with functional bracing for closed humeral shaft fractures and describe what factors are associated with this complication.

Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients.

Introduction: A care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LOS) ≥3 days in older adults with nonoperative pelvic ring fragility fractures and to highlight the challenging financial decision-making of those with IP LOS <3 days in the context of the Medicare 3-day rule.

Methods: This was a retrospective review of 322 patients aged ≥65 presenting from March 2016 and February 2019 to either of 2 emergency departments (EDs) after a ground-level fall resulting in a pelvic ring fracture.

Creative bracing: A descriptive overview of an alternative technique for non-operative fracture management of frail older adults.

As the world population ages, a higher proportion of older and frailer patients will sustain fragility fractures. Considering their depleted physiologic reserve and potentially different goals of care at their stage in life, these patients; especially those enrolled in hospice care, with profound dementia, or at end-of-life care; may not benefit from traditional surgical methods of fracture care. Non-operative treatment using standard immobilization or casting techniques in older and frailer patients can still render them susceptible to complications and adverse events.

A quality improvement project addressing the underreporting of delirium in hip fracture patients.

Introduction: After discovering a low incidence of delirium for hip fracture patients at our institution, we evaluated if this was due to underreporting and, if so, where process errors occurred.

Methods: Hip fracture patients aged ≥60 with a diagnosis of delirium were identified. Chart-Based Delirium Identification Instrument (CHART-DEL) identified missed diagnoses of delirium.

Outcomes After Revision Fixation With Cement Augmentation for Failed Intertrochanteric Fracture Fixation in Older Adult Patients.

Introduction: Intertrochanteric (IT) fractures that fail fixation are traditionally treated with arthroplasty, introducing significant risk of morbidity and mortality in frail older adult patients. Revision fixation with cement augmentation is a relatively novel technique that has been reported in several small scale international studies. Here we report a clinical series of 22 patients that underwent revision fixation with cement augmentation for IT fracture fixation failure.

AAOS Clinical Practice Guideline Summary: Management of Hip Fractures in Older Adults.

Fragility hip fractures are a major public health problem with a notable effect on quality of life for patients and their families. Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline serves as current evidence-based practice guidelines for orthopaedic surgeons in the management of this common fracture and is based on a systematic review of published studies examining the surgical treatment of hip fractures in adults aged 55 years and older (older adults). The lower age limit for the patient population was set at 55 years but was also required to have a median age of 65 years.

Hip Fracture Care in Parkinson Disease: A Retrospective Analysis of 1,239 Patients.

Introduction: Compared to other patients, Parkinson disease (PD) patients may experience suboptimal outcomes after hip fracture. The purpose of this study was to describe and compare characteristics and outcomes of hip fracture patients with PD to those without PD.

Methods: This retrospective cohort study included all patients admitted for hip fracture within a large healthcare system between July 1, 2017 and June 30, 2019.

Low-energy suspiciously open proximal humerus fracture management in older adult patient: A case report.

Although fractures of the proximal humerus are common among older adults, open fractures following low-energy trauma are exceptionally rare. Prior studies have alluded to the existence of this injury, but there are no detailed reports on its presentation, management, or long-term follow-up. We present the case of a 78-year-old man that sustained a suspiciously open proximal humerus fracture of the dominant hand following a fall down a few stairs.

Medial femoral circumflex artery pseudoaneurysm following intramedullary nailing for intertrochanteric fracture.

Case: We present the case of a 92-year-old woman who developed a medial femoral circumflex artery (MFCA) pseudoaneurysm intraoperatively while obtaining reduction during intramedullary nailing (IMN) for intertrochanteric fracture.

Conclusions: Pseudoaneurysms are rare vascular complications in hip fracture surgery. Early recognition of signs and symptoms of this phenomenon are essential for diagnosis and treatment.

Hip fracture care during the COVID-19 pandemic: retrospective cohort and literature review.

Objectives: The goal of this study was to investigate whether the COVID-19 pandemic has affected hip fracture care at a Level I Trauma hospital. The secondary goal was to summarize the published hip fracture reports during the pandemic.

Design: A retrospective cohort study.

Management of Geriatric Elbow Injury.

Approximately 4.1% of all fractures in the elderly involve the elbow. Most elbow injuries in geriatric patients occur as the result of low-energy mechanisms such as falls from standing height.

Own the Fall: AOA Critical Issues.

Falls are the most common cause of injury to older patients, resulting in >3 million emergency room visits per year and 290,000 hip fractures annually in the United States. Orthopaedic surgeons care for the majority of these patients; however, they are rarely involved in the assessment of fall risk and providing prevention strategies. Falls also occur perioperatively (e.

Minimizing Nonessential Follow-up for Hip Fracture Patients.

Introduction: Hip fractures pose a significant burden to patients and care providers. The optimal protocol for postoperative care across all surgically treated hip fracture patients is unknown. The purpose of this study was to investigate the effect that routine follow-up had on changing the clinical course.

Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic.

Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures.

Design: Retrospective cohort study.

Setting: A community hospital.

Fracture Risk Assessment: An Update.

➤: Our ability to accurately identify high fracture risk in individuals has improved as the volume of clinical data has expanded and fracture risk assessment tools have been developed.

➤: Given its accessibility, affordability, and low radiation exposure, dual x-ray absorptiometry (DXA) remains the standard for osteoporosis screening and monitoring response to treatment.

➤: The trabecular bone score (TBS) is a DXA software add-on that uses lumbar spine DXA imaging to produce an output that correlates with bone microarchitecture.

Low-Energy Pelvic Ring Fractures: A Care Conundrum.

Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide.

Development of a Questionnaire to Assess Patient Priorities in Hip Fracture Care.

Background: Patient reported outcome measures (PROMs) are becoming well recognized as an important component of health care outcomes and determinants of value in patient-centered care. Yet, there is emerging recognition that guidance is lacking in the utilization of PROMs in hip fracture patients. The aim of this study was to collect input from hip fracture patients and their health care advocates as proxies to identify outcomes that are important and to gain insight into which ones are of greatest importance.

Mobile Outreach: An Innovative Program for Older Orthopedic Patients in Care Facilities.

Introduction: The worldwide incidence of fragility fractures is increasing and the greatest burden is borne by the oldest population. Mobile Outreach, an innovative orthopedic-based program providing on-site musculoskeletal care for individuals in nursing care facilities, was implemented as part of our Geriatric Orthopaedic Trauma Program. The objectives of this report are to describe characteristics of patients cared for through Mobile Outreach and to report specific services provided.

Frequent 911 Fall Calls in Older Adults: Opportunity for Injury Prevention Strategies.

Objectives: To evaluate the utility of monitoring emergency medical services (EMS) call patterns to identify older adults who may benefit from targeted fall prevention and medical monitoring strategies.

Design: Retrospective chart review of EMS fall-related care. The HealthEMS database for the community surveyed was queried from January 1, 2007, through December 31, 2016.

Ten years of EMS Fall Calls in a Community: An Opportunity for Injury Prevention Strategies.

Objective: To determine whether fall calls, lift assists, and need for transport to the hospital over the past 10 years in one emergency medical services (EMS) system have altered coincident with demographic changes and to estimate health-care cost for lift assists.

Methods: We conducted a retrospective chart review of EMS fall-related care. The HealthEMS database for a suburban community surveyed was queried from March 1, 2007, to March 1, 2017.

A Prospective Look at the Link Between Frailty and Shoulder Function in Asymptomatic Elderly Individuals.

Introduction: The relationship between shoulder function and overall function in the elderly patients is not well understood. It is hypothesized that there is an increased tolerance of shoulder dysfunction in this population. The purpose of our study was to investigate and better understand the relationship between shoulder function, general musculoskeletal health, and frailty in the elderly patients.

Predictors of Mortality in Elder Patients With Proximal Humeral Fracture.

Background: Known possible consequences of proximal humerus fractures include impaired shoulder function, decreased independence, and increased risk for mortality. The purpose of this report is to describe the survival and independence of elderly patients with fractures of the proximal humerus, treated in our institution, relative to patient characteristics and treatment method.

Methods: Retrospective cohort study from 2006 to 2012.