Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T22:02:08.292Z Has data issue: false hasContentIssue false

Chapter 37 - Musculoskeletal Injuries

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Traumatic orthopedic injuries in the elderly patient present both a medical and surgical challenge. This growing population requires management tailored to specific patient needs and particular attention to bone quality and soft tissue management to avoid complications. Injury treatment is dependent on host factors, injury factors, and other special considerations in order to optimize outcome. The goal of treatment in the elderly patient is to allow for return to preinjury functional status, obtain fracture healing, and restore mobility. This chapter will focus on the treatment of some of the most common musculoskeletal injuries encountered in the elderly, including proximal humerus fractures, wrist fractures, hip fractures, ankle fractures, and vertebral compression fractures.

Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
, pp. 440 - 456
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Owens, WD, Felts, JA, Spitznagel, EL. ASA physical status classifications: A study of consistency of ratings. Anesthesiology. 1978; 49(4):239243.Google Scholar
McClure, J, Goldsborough, S. Fractured neck of femur and contralateral intracerebral lesions. J Clin Pathol. 1986; 39(8):920922.Google Scholar
Loder, RT. The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res. 1988; 232:210216.Google Scholar
Ganesh, SP, Pietrobon, R, Cecilio, WAC, Pan, D, Lightdale, N, Nunley, J. The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am. 2005; 87(8):17121718.Google Scholar
Ahmed, LA, Joakimsen, RM, Berntsen, GK, Fonnebo, V, Schirmer, H. Diabetes mellitus and the risk of non-vertebral fractures: The Tromso study. Osteoporos Int. 2006; 17(4):495500.Google Scholar
Egol, KA, Tejwani, NC, Walsh, MG, Capla, EL, Koval, KJ. Predictors of short-term functional outcome following ankle fracture surgery. J Bone Joint Surg Am. 2006; 88(5):974979.Google Scholar
Lane, JM, Vigorita, VJ. Osteoporosis. J Bone Joint Surg Am. 1983; 65(2):274278.CrossRefGoogle ScholarPubMed
Fulkerson, E, Egol, KA, Kubiak, EN, Liporace, F, Kummer, FJ, Koval, JK. Fixation of diaphyseal fractures with a segmental defect: A biomechanical comparison of locked and conventional plating techniques. J Trauma. 2006; 60(4):830835.Google Scholar
Bhutani, G, Gupta, MC. Emerging therapies for the treatment of osteoporosis. J Midlife Health. 2013; 4(3):147152.Google Scholar
Sammartino, A, Cirillo, D, Mandato, VD, Di Carlo, C, Nappi, C. Osteoporosis and cardiovascular disease: Benefit-risk of hormone replacement therapy. J Endocrinol Invest. 2005; 28(10 Suppl.):8084.Google Scholar
Gass, M, Dawson-Hughes, B. Preventing osteoporosis-related fractures: An overview. Am J Med. 2006; 119(4 Suppl. 1):S3S11.Google Scholar
Kalu, DN, Masoro, EJ. The biology of aging, with particular reference to the musculoskeletal system. Clin Geriatr Med. 1988; 4(2):257267.Google Scholar
Tomonaga, M. Histochemical and ultrastructural changes in senile human skeletal muscle. J Am Geriatr Soc. 1977; 25(3):125131.CrossRefGoogle ScholarPubMed
McCarter, R. Effects of age on contraction of mammalian skeletal muscle. In: Kalkor, JDG, ed. Aging in Muscle. New York: Raven Press, 1978, pp. 122.Google Scholar
Murray, MP, Duthie, EH, Gambert, SR, Sepic, SB, Mollinger, LA. Age-related differences in knee muscle strength in normal women. J Gerontol. 1985; 40(3):275280.Google Scholar
Broos, PL, Stappaerts, KH, Rommens, PM, Louette, LK, Gruwez, JA. Polytrauma in patients of 65 and over: Injury patterns and outcome. Int Surg. 1988; 73(2):119122.Google Scholar
Martin, RE, Teberian, G. Multiple trauma and the elderly patient. Emerg Med Clin North Am. 1990; 8(2):411420.Google Scholar
DeMaria, EJ, Kenney, PR, Merriam, MA, Casanova, LA, Gann, DS. Survival after trauma in geriatric patients. Ann Surg. 1987; 206(6):738743.Google Scholar
Horst, HM, Obeid, FN, Sorensen, VJ, Bivins, BA. Factors influencing survival of elderly trauma patients. Crit Care Med. 1986; 14(8):681684.CrossRefGoogle ScholarPubMed
Oreskovich, MR, Howard, JD, Copass, MK, Carrico, CJ. Geriatric trauma: Injury patterns and outcome. J Trauma. 1984; 24(7):565572.Google Scholar
Bone, L, Bucholz, R. The management of fractures in the patient with multiple trauma. J Bone Joint Surg Am. 1986; 68(6):945949.Google Scholar
Gustilo, RB, Anderson, JT. 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):453458.CrossRefGoogle ScholarPubMed
Gustilo, RB, Simpson, L, Nixon, R, Ruiz, A, Indeck, W. Analysis of 511 open fractures. Clin Orthop Relat Res. 1969; 66:148154.Google Scholar
Cornell, CN, Lane, JM, Poynton, AR. Orthopedic management of vertebral and long bone fractures in patients with osteoporosis. Clin Geriatr Med. 2003; 19(2):433455.Google Scholar
Salter, RB, Simmonds, DF, Malcolm, BW, Rumble, EJ, MacMichael, D, Clements, ND. 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):12321251.Google Scholar
Clain, A. Secondary malignant disease of bone. Br J Cancer. 1965; 19:1529.Google Scholar
Jaffe, H. Tumors and Tumorous Conditions of Bones and Joint. Philadelphia, PA: Lea & Febiger, 1958.Google Scholar
Parrish, FF, Murray, JA. Surgical treatment for secondary neoplastic fractures: A retrospective study of ninety-six patients. J Bone Joint Surg Am. 1970; 52(4):665686.Google Scholar
Harrington, K. Impending pathologic fractures from metastatic malignancy: Evaluation and management. In: Anderson, L., ed. American Academy of Orthopaedic Surgeons Instructional Course Lectures XXXV. St. Louis, MO: C. V. Mosby, 1986, pp. 357381.Google Scholar
Papapetrou, PD. Bisphosphonate-associated adverse events. Hormones (Athens). 2009; 8(2):96110.Google Scholar
Neviaser, AS, Lane, JM, Lenart, BA, Edobor-Osula, F, Lorich, D. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008; 22(5):346350.CrossRefGoogle ScholarPubMed
Odvina, CV, Zerwekh, JE, Rao, DS, Maalouf, N, Gottschalk, FA, Pak, CYC. Severely suppressed bone turnover: A potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005; 90(3):12941301.Google Scholar
Shane, E, Burr, D, Abrahamsen, B, Adler, RA, Brown, TD, Cheung, AM, 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. 2014; 29(1):123.Google Scholar
Sexson, SB, Lehner, JT. Factors affecting hip fracture mortality. J Orthop Trauma. 1987; 1(4):298305.Google Scholar
Kenzora, JE, McCarthy, RE, Lowell, JD, Sledge, CB. Hip fracture mortality: Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984; 186:4556.Google Scholar
Zuckerman, JD, Skovron, , Koval, KJ, Aharonoff, G, Frankel, VH. 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):15511556.Google Scholar
Davis, FM, Woolner, DF, Frampton, C, Wilkinson, A, Grant, A, Harrison, RT, 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):10801088.Google Scholar
Valentin, N, Lomholt, B, Jensen, JS, Hejgaard, , Kreiner, S. Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. Br J Anaesth. 1986; 58(3):284291.Google Scholar
Modig, J, Borg, T, Karlstrom, G, Maripuu, E, Sahlstedt, B. Thromboembolism after total hip replacement: Role of epidural and general anesthesia. Anesth Analg. 1983; 62(2):174180.Google Scholar
Brody, JA. Prospects for an ageing population. Nature. 1985; 315(6019):463466.Google Scholar
Frandsen, PA, 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):681686.Google Scholar
Cooper, C, Campion, G, Melton, LJ. Hip fractures in the elderly: A world-wide projection. Osteoporos Int. 1992; 2:285289.CrossRefGoogle ScholarPubMed
Greenspan, SL, Myers, ER, Maitland, LA, Resnick, NM, Hayes, WC. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA. 1994; 271(2):128133.Google Scholar
Hinton, RY, Smith, GS. 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):752759.Google Scholar
Rizzo, PF, Gould, ES, Lyden, JP, Asnis, SE. Diagnosis of occult fractures about the hip. Magnetic resonance imaging compared with bone-scanning. J Bone Joint Surg Am. 1993; 75(3):395401.Google Scholar
Colwell, CW, /soiro, TE, Trowbridge, AA, Morris, BA, Kwaan, HC, Blaha, JD, 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):314.Google Scholar
Geerts, WH, Jay, RM, Code, KI, Chen, E, Szalai, JP, Saibil, EA, 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):701707.Google Scholar
Merli, GJ. Update: Deep vein thrombosis and pulmonary embolism prophylaxis in orthopedic surgery. Med Clin North Am. 1993; 77(2):397411.CrossRefGoogle ScholarPubMed
Kinov, P, Tanchev, PP, Ellis, M, Volpin, G. Antithrombotic prophylaxis in major orthopaedic surgery: An historical overview and update of current recommendations. Int Orthop. 2014; 38(1):169175.Google Scholar
Koval, KJ, Skovron, ML, Aharonoff, GB, Meadows, SE, Zuckerman, JD. Ambulatory ability after hip fracture: A prospective study in geriatric patients. Clin Orthop Relat Res. 1995; 310:150159.Google Scholar
White, BL, Fisher, WD, Laurin, CA. Rate of mortality for elderly patients after fracture of the hip in the 1980s. J Bone Joint Surg Am. 1987; 69(9):13351340.Google Scholar
Tajeu, GS, Delzell, E, Smith, W, Arora, T, Curtis, JR, Saag, KG, et al. Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci. 2014; 69A(3):346353.Google Scholar
Aharonoff, GB, Koval, KJ, Skovron, ML, Zuckerman, JD. Hip fractures in the elderly: Predictors of one year mortality. J Orthop Trauma. 1997; 11(3):162165.Google Scholar
Fixation using Alternative Implants for the Treatment of Hip fractures Investigators. Fracture fixation in the operative management of hp fractures (FAITH): An international, multicentre, randomised controlled trial. Lancet. 2017; 389(10078):15191527.Google Scholar
Lewis, DP, Waever, D, Thorninger, R, Donnelly, WJ. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: A systematic review and meta-analysis. J Arthroplasty. 2019; 34(8):18371843.Google Scholar
Chammout, G, Kelly-Peterson, P, Hedbeck, CJ, Stark, A, Mukka, S, Skoldenberg, O. HOPE-Trial: Hemiarthroplasty compared with total hip arthroplasty for displaced femoral neck fractures in octogenarians – A randomized controlled trial. JBJS Open Access. 2019 (May 1); 4(2):e0059.Google Scholar
Guyen, O. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res. 2019; 105(1 Suppl.):S95101.Google Scholar
Inngul, C, Blomfeldt, , Ponzer, S, Enocson, A. Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck: A randomised controlled trial. Bone Joint J. 2015; 97B(11):14751480.Google Scholar
Veldman, HD, Heyligers, IC, Grimm, B, Boymans, TA. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: A systematic review and meta-analysis of current generation hip stems. Bone Joint J. 2017; 99B(4):421431.Google Scholar
Makela, KT, Matilainen, M, Pulkkinen, P, Fenstad, AM, Havelin, L, Engesaeter, L, et al. Failure rate of cemented and uncemented total hip replacements: Register study of combined Nordic database of four nations. BMJ. 2014 (Jan. 13); 348:f7592.Google Scholar
Probe, R, Ward, R. Internal fixation of femoral neck fractures. J Am Acad Orthop Surg. 2006; 14(9):565571.Google Scholar
Schmidt, AH, Swiontkowski, MF. Femoral neck fractures. Orthop Clin North Am. 2002; 33(1):97111, viii.Google Scholar
Keating, JF, Grant, A, Masson, M, Scott, NW, Forbes, JF. 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):249260.CrossRefGoogle ScholarPubMed
Gupta, RK, Sangwan, K, Kamboj, P, Punia, SS, Walecha, P. Unstable intertrochanteric fractures: The role of lateral wall reconstruction. Int Orthop. 2010; 34(1):125129.Google Scholar
Lu, Y, Uppal, HS. Hip fractures: Relevant anatomy, classification, and biomechanics of fracture and fixation. Geriatr Orthop Surg Rehabil. 2019; 10:2151459319859139.CrossRefGoogle Scholar
Baumgaertner, MR, Curtin, SL, Lindskog, DM, Keggi, JM. The value of the tip–apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995; 77(7):10581064.CrossRefGoogle ScholarPubMed
Reindl, R, Harvey, EJ, Berry, GK, Rahme, E, Canadian Orthopaedic Trauma Society (COTS). Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: A prospective randomized controlled trial. J Bone Joint Surg Am. 2015; 97(23): 19051912.Google Scholar
Sanders, D, Bryant, D, Tieszer, C, Lawendy, AR, MacLeod, M, Papp, S. A multicenter randomized control trial comparing a novel intramedullary device (InterTAN) versus conventional treatment (Sliding Hip Screw) of geriatric hip fractures. J Orthop Trauma. 2017; 31(1):18.Google Scholar
Stiell, IG, McKnight, RD, Greenberg, GH, McDowell, I, Nail, RC, Wells, GA, et al. Implementation of the Ottawa ankle rules. JAMA. 1994; 271(11):827832.Google Scholar
McConnell, T, Creevy, W, Tornetta, P. Stress examination of supination external rotation-type fibular fractures. J Bone Joint Surg Am. 2004; 86–A(10):21712178.CrossRefGoogle ScholarPubMed
Kadakia, RJ, Ahearn, BM, Schwartz, AM, Tenenbaum, S, Bariteau, JT. Ankle fractures in the elderly: Risks and management challenges. Orthop Res Rev. 2017; 9:4550.Google Scholar
Mears, SC, Kates, SL. A guide to improving the care of patients with fragility fractures, edition 2. Geriatr Orthop Surg Rehabil. 2015; 6(2):58120.Google Scholar
Ramsey, PL, Hamilton, W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am. 1976; 58(3):356357.Google Scholar
Hulsker, CC, Kleinveld, S, Zonnenberg, CBL, Hogervorst, M, van den Bekerom, MPJ. Evidence-based treatment of open ankle fractures. Arch Orthop Trauma Surg. 2011; 131(11):15451553.Google Scholar
Herrera-Perez, M, Gutierrez-Morales, M, Guerra-Ferraz, A, Pais-Brito, JL, Boluda-Mengod, J, Garces, GL. Locking versus non-locking one-third tubular plates for treating osteoporotic distal fibula fractures: a comparative study. Injury. 2017; 48(Suppl. 6):S6065.Google Scholar
Schumaier, A, Grawe, B. Proximal humerus fractures: evaluation and management in the elderly patient. Geriatr Orthop Surg Rehabil. 2018; 9:2151458517750516.Google Scholar
Neer, CS. Displaced proximal humeral fractures II: Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970; 52(6):10901103.Google Scholar
Neer, CS. Displaced proximal humeral fractures I. Classification and evaluation. J Bone Joint Surg Am. 1970; 52(6):10771089.Google Scholar
Berghdal, C, Ekholm, C, Wennergren, D, Nilsson, F, Moller, M. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: Data from the Swedish Fracture Register. BMC Musculoskelet Disord. 2016 (Apr. 12); 17:159.Google Scholar
Boons, HW, Goosen, JH, van Grinsven, S, van Susante, JL, van Loon, CJ. Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: A randomized controlled trial. Clin Orthop Relat Res. 2012; 470(12):34833491.Google Scholar
Mata-Fink, A. Meinke, M, Jones, C, Kim, B, Bell, JE. Reverse shoulder arthroplasty for treatment of proximal humeral fractures in older adults: A systematic review. J Shoulder Elbow Surg. 2013; 22(12):17371748.Google Scholar
Sebastia-Forcaca, E, Cebrian-Gomez, R, Lizaur-Utrilla, A, Gil-Guillen, V. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures: A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg. 2014; 23(10):14191426.Google Scholar
Scott, LS, Rozell, JC, Pulos, N. Distal radius fractures in the elderly. J Am Acad Orthop Surg. 2017; 25(3):179187.Google Scholar
Alffram, PA, Bauer, GC. Epidemiology of fractures of the forearm: A biomechanical investigation of bone strength. J Bone Joint Surg Am. 1962; 44–A:105114.Google Scholar
Rozental, TD, Blazar, PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006; 31(3):359365.Google Scholar
Young, BT, Rayan, GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am. 2000; 25(1):1928.Google Scholar
Arora, R, Lutz, M, Demi, C, Krappinger, D, Haug, L, Gabl, M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am. 2011; 93(23):21462153.Google Scholar
Majd, ME, Farley, S, Holt, RT. Preliminary outcomes and efficacy of the first 360 consecutive kyphoplasties for the treatment of painful osteoporotic vertebral compression fractures. Spine J. 2005; 5(3):244255.CrossRefGoogle ScholarPubMed
Prather, H, Van Dillen, L, MEtzler, JP, Riew, DK, Gilula, LA. Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty. J Bone Joint Surg Am. 2006; 88(2):334341.Google Scholar
Kallmes, DF, Comstock, BA, Heagerty, PJ, Turner, JA, Wilson, DJ, Diamond, TH, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009; 361(6):569579.Google Scholar
Buchbinder, R, Osborne, RH, Ebeling, PR, Wark, JD, Mitchell, P, Wriedt, C, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009; 361(6):557568.Google Scholar
Anderson, PA, Froyshteter, AB, Tontz, WL. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013; 28(2):372382.Google Scholar
Ma, XL, Xing, D, Ma, JX, Xu, WG, Wang, J, Chen, Y. Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: Grading the evidence through a systematic review and meta-analysis. Eur Spine J. 2012; 21(9):18441859.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×