Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures

With the global over 60-year-old population predicted to more than double over the next 35 years, caring for this aging population has become a major global healthcare challenge. In 2016 there were over 1 million deaths in >70 year olds due to lower respiratory tract infections; 13–31% of these have been reported to be caused by viruses. Since then, there has been a global COVID-19 pandemic, which has caused over 2.3 million deaths so far; increased age has been shown to be the biggest risk factor for morbidity and mortality. Thus, the burden of respiratory viral infections in the elderly is becoming an increasing unmet clinical need. Particular challenges are faced due to the interplay of a variety of factors including complex multimorbidities, decreased physiological reserve and an aging immune system. Moreover, their atypical presentation of symptoms may lead to delayed necessary care, prescription of additional drugs and prolonged hospital stay. This leads to morbidity and mortality and further nosocomial spread. Clinicians currently have limited access to sensitive detection methods. Furthermore, a lack of effective antiviral treatments means there is little incentive to diagnose and record specific non-COVID-19 viral infections. To meet this unmet clinical need, it is first essential to fully understand the burden of respiratory viruses in the elderly. Doing this through prospective screening research studies for all respiratory viruses will help guide preventative policies and clinical trials for emerging therapeutics. The implementation of multiplex point-of-care diagnostics as a mainstay in all healthcare settings will be essential to understand the burden of respiratory viruses, diagnose patients and monitor outbreaks. The further development of novel targeted vaccinations as well as anti-viral therapeutics and new ways to augment the aging immune system is now also essential. The reviews of this paper are available via the supplemental material section.

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Hip fractures among the elderly in Kyoto, Japan: a 10-year study

Archives of Osteoporosis ◽

10.1007/s11657-021-00888-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maki Asada ◽

Motoyuki Horii ◽

Kazuya Ikoma ◽

Tsuyoshi Goto ◽

Naoki Okubo ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Incidence Rate ◽

Acute Care ◽

Hip Fractures ◽

Age Groups ◽

The Elderly ◽

Femoral Neck Fractures ◽

Age Group ◽

Trochanteric Fractures

Abstract Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

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Operative Versus Nonoperative Management of Odontoid Fracture in the Elderly: Stochastic Simulation of Morbidity and Mortality

The Spine Journal ◽

10.1016/j.spinee.2011.08.266 ◽

2011 ◽

Vol 11 (10) ◽

pp. S107

Author(s):

Suneel Bhat ◽

Christopher Kepler ◽

Kris Radcliff ◽

Jeffrey Rihn ◽

Todd Albert ◽

...

Keyword(s):

Stochastic Simulation ◽

Nonoperative Management ◽

The Elderly ◽

Odontoid Fracture ◽

Morbidity And Mortality

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Should comminuted trochanteric fractures of the hip in the elderly be reduced before fixation?

Injury ◽

10.1016/0020-1383(87)90012-x ◽

1987 ◽

Vol 18 (4) ◽

pp. 270-273 ◽

Cited By ~ 2

Author(s):

G.B.K. Verghese ◽

D. Jaffray

Keyword(s):

The Elderly ◽

Trochanteric Fractures

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Breakage of a Third Generation Gamma Nail: A Case Report and Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2013/172352 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

Takashi Iwakura ◽

Takahiro Niikura ◽

Sang Yang Lee ◽

Yoshitada Sakai ◽

Kotaro Nishida ◽

...

Keyword(s):

Rare Complication ◽

Trochanteric Fracture ◽

High Strength ◽

The Elderly ◽

Gamma Nail ◽

Bipolar Hemiarthroplasty ◽

Third Generation ◽

Trochanteric Fractures ◽

Cemented Bipolar Hemiarthroplasty ◽

Fractures Of The Femur

The use of intramedullary nails to treat trochanteric fractures of the femur has increased with the increasing size of the elderly population. The third generation Gamma nail is currently one of the most popular devices for the treatment of trochanteric fractures. Nail breakage is a rare complication, possibly resulting from fatigue fracture of the implant. We present the first reported case of breakage of a third generation Gamma nail that was not used to treat a pathological fracture. An 83-year-old woman with an unstable trochanteric fracture of the femur was treated using a third generation Gamma nail. She was referred to our hospital 14 months postoperatively with nail breakage at the opening for the lag screw. The breakage was secondary to nonunion, which was thought to be mainly due to insufficient reduction of the fracture. The broken nail was removed, and the patient underwent cemented bipolar hemiarthroplasty. At followup 18 months later, she was mobile with a walker and asymptomatic with no complications. This case shows that inadequate operation such as insufficient reduction of the trochanteric fracture may result in nonunion and implant breakage, even when using a high-strength, well-designed implant.

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Early Operation in the Elderly?

Neurosurgical Standards Cerebral Aneurysms Malignant Gliomas - Advances in Neurosurgery ◽

10.1007/978-3-642-77109-5_20 ◽

1992 ◽

pp. 123-128

Author(s):

A. Laun ◽

C. Eulgem ◽

O. Hoffmann

Keyword(s):

The Elderly ◽

Early Operation

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Anaesthesia in the elderly

10.1093/med/9780199642045.003.0086 ◽

2017 ◽

Author(s):

Bernadette Veering ◽

Chris Dodds

Keyword(s):

Elderly Patients ◽

Postoperative Morbidity ◽

Medical Condition ◽

Clinical Care ◽

The Elderly ◽

Individual Variability ◽

Morbidity And Mortality ◽

Clear Understanding ◽

Organ Systems ◽

Specific Organ

The elderly population continues to grow. As surgical intervention in disease processes becomes more aggressive, the anaesthetist is faced with an increasing number of elderly patients. Elderly patients should be approached with a clear understanding of ageing, how it occurs, how it affects specific organ systems, and how it may influence clinical care, when a patient is subjected to an operation. The ageing process is a multifactorial process, resulting in a decreased capacity for adaptation and producing a gradual decrease in functional reserve of many organ systems. This has significant effects on the physiological responses to surgical and pharmacological trespass faced during anaesthesia. Increasing age is associated with changes in the response to a wide variety of drugs. Changes in dose–response relationships may be as a result of changes in pharmacokinetics, pharmacodynamics, or a combination of both. One should realize that increasing age is associated with a large inter-individual variability in dose requirements. As such, it is important to carefully titrate the dose against the desired clinical effect in an older patient. Preoperative physical and mental state are the most important determinants of per- and postoperative morbidity and mortality. The number of co-morbidities increases with advanced age and as such, optimization of the medical condition is essential to reduce the morbidity and mortality.

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