Frakturen im Alter

Im Alter können bereits Niedrigenergietraumata wie Stolperstürze zu schwerwiegenden Verletzungen führen, deren Folgen ernsthafte Auswirkungen auf die Lebensqualität der Patienten haben. Zu den häufigsten Frakturen älterer Patienten gehören Hüft- und Wirbelkörperfrakturen, gefolgt von Frakturen des Schulter-/Handgelenks und Rippenfrakturen. Der Artikel arbeitet die Besonderheiten der Versorgung dieser geriatrischen Patienten heraus.

Schlüsselwörter

Geriatrie - Traumatologie - Sturz - Osteoporose - Unfallchirurgie

• Literatur

• 1 Sambrook PN, Cameron ID, Chen JS. et al. Influence of fall related factors and bone strength on fracture risk in the frail elderly. Osteoporos Int 2007; 18: 603-610
• 2 Rau CS, Lin TS, Wu SC. et al. Geriatric hospitalizations in fall-related injuries. Scand J Trauma Resusc Emerg Med 2014; 22: 63
• 3 Friedman SM, Mendelson DA. Epidemiology of fragility fractures. Clin Geriatr Med 2014; 30: 175-181
• 4 Haussler B, Gothe H, Gol D. et al. Epidemiology, treatment and costs of osteoporosis in Germany-the BoneEVA Study. Osteoporos Int 2007; 18: 77-84
• 5 Baroni M, Serra R, Boccardi V. et al. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int 2019; 30: 907-916 doi:10.1007/s00198-019-04858-2
• 6 McCusker J, Bellavance F, Cardin S. et al. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 1999; 1229-1237
• 7 Irlbeck T, Zwissler B, Bauer A. ASA-Klassifikation. Wandel im Laufe der Zeit und Darstellung in der Literatur. Anaesthesist 2017; 66: 5-10
• 8 Brusselaers N, Lagergren J. The Charlson Comorbidity Index in registry-based research. Meth Inform Med 2017; 56: 401-406
• 9 Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993; 75: 797-798
• 10 Hernlund E, Svedbom A, Ivergard M. et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8: 136
• 11 European Prospective Osteoporosis Study Group. Felsenberg D, Silman AJ. et al. Incidence of vertebral fracture in europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 2002; 17: 716-724
• 12 DVO – Dachverband Osteologie. DVO-Leitlinie Osteoporose 2017. Im Internet (Stand: 10.09.2019): https://www.dv-osteologie.org/dvo_leitlinien/dvo-leitlinie-2017
• 13 Brolin K. Neck injuries among the elderly in Sweden. Inj Control Saf Promot 2003; 10: 155-164
• 14 Scharen S, Jeanneret B. Atlasfrakturen. Orthopäde 1999; 28: 385-393
• 15 Anderson LD, DʼAlonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974; 56: 1663-1674
• 16 Effendi B, Roy D, Cornish B. et al. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br 1981; 63: 319-327
• 17 Horn EM, Theodore N, Feiz-Erfan I. et al. Complications of halo fixation in the elderly. J Neurosurg Spine 2006; 5: 46-49
• 18 Wang H, Coppola M, Robinson RD. et al. Geriatric trauma patients with cervical spine fractures due to ground level fall: five years experience in a level one trauma center. J Clin Med Res 2013; 5: 75-83
• 19 Longo UG, Loppini M, Denaro L. et al. Conservative management of patients with an osteoporotic vertebral fracture: a review of the literature. J Bone Joint Surg Br 2012; 94: 152-157
• 20 Bostrom MP, Lane JM. Future directions. Augmentation of osteoporotic vertebral bodies. Spine 1997; 22: 38S-42S
• 21 Krappinger D, Kastenberger TJ, Schmid R. Die Behandlung osteoporotischer Wirbelkörperfrakturen mit augmentierter Instrumentation. Operative Orthopädie und Traumatologie 2012; 24: 4-12
• 22 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury 2013; 44: 1733-1744
• 23 Tiefenbach M, Scheel M, Maier A. et al. Osteomalazie – Klinik, Diagnostik und Therapie. Z Rheumatol 2018; 77: 703-718
• 24 Neer CS. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970; 52: 1090-1103
• 25 Böhler J. Die Komplexverletzung der Hand. Taktik der Sofortversorgung frischer Verletzungen. Unfallheilkunde 1977; 80: 39-42
• 26 Kammerlander C, Gosch M, Kammerlander-Knauer U. et al. Long-term functional outcome in geriatric hip fracture patients. Arch Orthopaed Trauma Surg 2011; 131: 1435-1444
• 27 Kammerlander C, Pfeufer D, Lisitano LA. et al. Inability of older adult patients with hip fracture to maintain postoperative weight-bearing restrictions. J Bone Joint Surg Am 2018; 100: 936-941
• 28 Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 1961; 43: 647-663
• 29 Nauth A, Creek AT, Zellar A. et al. Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet 2017; 389: 1519-1527
• 30 Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect 1995; 44: 293-304
• 31 Kammerlander C, Kates SL, Wagner M. et al. Minimally invasive periprosthetic plate osteosynthesis using the locking attachment plate. Operat Orthop Traumatol 2013; 25: 398-408 410
• 32 El-Zayat BF, Ruchholtz S, Efe T. et al. NCB-plating in the treatment of geriatric and periprosthetic femoral fractures. Orthop Traumatol Surg Res 2012; 98: 765-772
• 33 Shane E, Burr D, Abrahamsen B. 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: 1-23
• 34 Johnell K, Fastbom J. Undertreatment of osteoporosis in the oldest old? A nationwide study of over 700,000 older people. Arch Osteoporos 2009; 4: 17-23