<p>As the population of elderly people has increased, so too has the incidence of hip fracture. While injuries to the hips are common, they can be quite complicated and require both surgical and non-surgical approaches to treatment and management. J. Zuckerman, MD, Chairman, Dep. of Orthopaedic Surg
Geriatric Hip Fractures: A Practical Approach
â Scribed by Nicholas C. Danford (editor), Justin K. Greisberg (editor), Charles M. Jobin (editor), Melvin P. Rosenwasser (editor), Marcella D. Walker (editor)
- Publisher
- Springer
- Year
- 2021
- Tongue
- English
- Leaves
- 256
- Category
- Library
No coin nor oath required. For personal study only.
⌠Synopsis
The global burden of geriatric hip fractures is enormous. From both the patient's and physicianâs perspective, the injury is complex. A hip fracture often changes a patientâs life and/or the life of the patientâs family permanently. From the physicianâs perspective, care of geriatric hip fracture patients requires a multidisciplinary team, which is led by the surgeon and which includes internists and other subspecialists within internal medicine, anesthesiologists, nurses, operating room technicians, social workers, physical therapists, and rehabilitation center coordinators and staff. Nowhere in the orthopedic literature is there a text that guides care for these complex patients from injury through recovery.
This text is the first to do so by organizing and synthesizing a large body of literature. Its main themes include pre-operative, operative, and post-operative care of the patient who sustains a geriatric hip fracture. Its main objective is to organize the current body of literature into a cohesive whole so that the busy orthopedic surgeon does not have to undertake a literature search each time he or she wants an answer to the myriad questions that characterize a patientâs injury, treatment, and recovery course. With regard to pedagogy, because orthopedic surgeons in training will utilize this book, and because the case study is the central pedagogical tool in the field of orthopedic surgery, this book includes case studies within each chapter, with the authorâs preferred treatment and decision-making rationale for each case. Selected video supplements reinforce real-world application of knowledge.
Practicing orthopedic surgeons, as well as orthopedic residents and fellows in training, will find Geriatric Hip Fractures: A Practical Approach a highly useful and informative resource.
⌠Table of Contents
Contents
Contributors
Chapter 1: Introduction: History of Geriatric Hip Fracture Treatment
History of Geriatric Hip Fracture Treatment
The Early Years: Non-operative Treatment
Moving Toward Modern Treatment: Early Operative Techniques
References
Chapter 2: Initial Workup, Diagnosis, and Fracture Classification for Geriatric Hip Fractures
Initial Workup and Diagnosis
History
Examination
Imaging
Laboratory Workup and Preoperative Clearance
Fracture Classification
Femoral Neck
Peritrochanteric
Periprosthetic
References
Chapter 3: Perioperative Medical Co-management of Patients with Geriatric Hip Fractures
Introduction
Initial Medical Workup for Hip Fracture
Laboratory Evaluation
Other Studies
Medication Reconciliation
Risk Assessment Tools
Perioperative Considerations
Analgesia
Perioperative Antibiotic Prophylaxis
DVT Prophylaxis
Postoperative Complications
Cardiac
Pulmonary
Neuro-Delirium
Gastrointestinal
Renal
Infectious
Urinary Tract Infection
Wound
COVID
Clostridium difficile
Hematologic
Endocrine
Nutrition
Decubiti Ulcers
Perioperative Co-management
References
Chapter 4: Applied Anatomy for Treatment of Geriatric Hip Fractures
Introduction
Part 1: Anatomic Considerations in Geriatric Patients
Age-Related Osseous Changes of the Proximal Femur
Age-Related Changes to Muscle
Part 2: Applied Surgical Anatomy of the Hip
Vascular Supply and Risk of Osteonecrosis
The Hip Capsule
Pericapsular Anatomy
Part 3: Surgical Decision-Making
Intracapsular Versus Extracapsular Fractures
Minimally Displaced Intracapsular Fractures
Displaced Intracapsular Fractures
Extracapsular Fractures
Open Reduction Techniques
Conclusions
References
Chapter 5: Surgical Treatment of Pertrochanteric Hip Fractures
Timing of Surgery
Hip Fracture Medical Co-management
Implant Selection
Plates and Screws
Fixed Angle Plates
Sliding Hip Screw
Medoff Sliding Plate
Lateral Trochanteric Stabilizing Plate
Intramedullary Nails
Cephalomedullary Nail
Short Nails
Other Options
External Fixator
Arthroplasty
Preoperative Checklist
Positioning
Reduction of Fracture
Lag Screw Position
Surgical Techniques
Sliding Hip Screw
Cephalomedullary Nail
Wound Closure
Postoperative Protocol
Hemoglobin/Hematocrit Monitoring and Transfusion Threshold
Subtrochanteric Femur Fractures
Complications
Lag Screw Cut-Out
Nonunion
Fracture-Related Infection
Refracture
Implant Breakage
Avascular Necrosis of the Femoral Head
Vascular Injury
Summary
References
Chapter 6: Surgical Treatment of Femoral Neck Fractures
Epidemiology of Femoral Neck Fractures in Geriatric Patients
Economic Impact and Incidence
Age Distribution
Risk Factors
Morbidity and Mortality
Impact on Quality of Life
Applied Surgical Anatomy of the Proximal Femur
Osteology of the Femoral Neck
Vascular Supply of the Proximal Femur
Surgical Approaches to the Hip
Direct Anterior
Anterolateral
Direct Lateral
Posterior
Comparison of Approaches
Clinical Presentation and Initial Management
History and Physical Exam
Radiographic Evaluation
Plain Film Radiographs
Role of Advanced Imaging
Fracture Classification
Intracapsular and Extracapsular Fractures
Garden Classification
Pauwels Classification
AO/OTA
Non-operative Treatment of Femoral Neck Fractures
Indications for Non-operative Treatment
Complications of Non-operative Treatment
Prevention of Non-operative Complications
Closed Reduction Percutaneous Pinning
General Principles and Indications
Surgical Technique
Perioperative Care
Postoperative Outcomes and Complications
Open Reduction Internal Fixation (ORIF)
General Principles and Indications
Surgical Technique
Perioperative Care
Postoperative Outcomes and Complications
Hemiarthroplasty and Total Hip Arthroplasty
General Principles and Indications
Surgical Technique
Perioperative Care
Postoperative Outcomes and Complications
Implant Considerations
Femoral Stems Selection
Femoral Head Component Selection
Arthroplasty Versus Fixation
Conclusion and Authors Recommendations
References
Chapter 7: Periprosthetic Femur Fractures After Total Hip Arthroplasty
Introduction
Risk Factors
Clinical Evaluation
History and Physical Examination
Imaging Studies
Laboratory Investigations
Classification
Intraoperative Vancouver Classification
Postoperative Vancouver Classification
Management
Vancouver Type A
Vancouver Type B1
Vancouver Type B2
Extensively Porous-Coated Stems
Modular Tapered Stems
Vancouver Type B3
Vancouver Type C
Outcomes and Complications
Conclusions
References
Chapter 8: Pathologic Hip Fractures in the Geriatric Patient
Introduction
Etiology
Epidemiology
Pathophysiology
Evaluation
History and Physical
Laboratory Evaluation
Imaging
Biopsy
Prognosis
Management
Nonsurgical
Surgical
Neoadjuvant
Adjuvant
Complications
Outcomes
Function
Conclusion
References
Chapter 9: Outcome Assessment and Quality Improvement for Geriatric Hip Fractures
History of Geriatric Hip Fractures Outcome Assessment
Radiographic Outcome Assessment
Clinical Outcome Assessment and Patient-Reported Outcome Measures
Patient-Reported Outcomes Measurement Information System (PROMIS)
Understanding Levels of Evidence in Geriatric Hip Fracture Outcome Assessment
Recommendations for Evaluating Outcomes
Quality Improvement in Geriatric Hip Fracture Care
The Surgeonâs Role in Using Outcome Research and in Quality Improvement
Conclusion
References
Chapter 10: Rehabilitation After Geriatric Hip Fractures
History of Rehabilitation After Geriatric Hip Fracture
Our Approach to Rehabilitation After Geriatric Hip Fracture
Weight Bearing
Inpatient Physical Therapy
Pain Control
Patient Disposition: Rehabilitation Center Versus Home Discharge
Interdisciplinary Care: Who and to What Extent
Nutrition: Often Overlooked
Psychosocial Aspects of Rehabilitation: Mental Health and Family Support
Conclusions
References
Chapter 11: Postoperative Bone Mineral Health Optimization in the Geriatric Patient
Introduction
Evaluation for Osteoporosis in the Hip Fracture Patient
Lifestyle Modifications
Pharmacologic Therapy
Anti-resorptive Agents
Bisphosphonates
Denosumab
Anabolic Agents
Parathyroid Hormone and Parathyroid Hormone-Related Peptide Analogs
Combination Anabolic/Anti-resorptive Agents
Estrogen Replacement Therapy
Selective Estrogen Receptor Modulators
Calcitonin
Timing of Treatment
Summary
References
Chapter 12: Geriatric Hip Fracture Care in Low- and Middle-Income Countries
Introduction
Epidemiology
The Hip Fracture Epidemic: Aging Populations in LMICs
Global Burden of Disease: Death and Disability
Economic Impact: Direct and Indirect, Individual and Societal
Risk Factors
Non-modifiable Factors: Age and Sex
Modifiable Risks: Fragility, Frailty, and Falls
Preoperative Management
Orthogeriatric Co-management
Prophylactic Antibiotics
Anticoagulation and Anemia
Anesthesia and Pain Management
Operative Intervention
Timing of Surgery
First Delay â Seeking Care
Second Delay â Reaching Care
Third Delay â Receiving Care
Non-operative Treatment
Osteosynthesis and Affordable Implants
Arthroplasty
Postoperative Management
Complications
Mortality
Thromboembolic Events
Infections
Delirium
Subsequent Fractures
Fracture Liaison Services
Rehabilitation
Interventions
Education
Research
Conclusion
References
Chapter 13: Geriatric Hip Fractures: Economics of Care
Introduction
Risk Stratification and Protocolization
Co-management and Interdisciplinary Care
Surgical Timing
Postoperative Care and Disposition
Modern Payment Models
Authorâs Recommendations
References
Index
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