Fractures in the Elderly (eBook)
XII, 335 Seiten
Humana Press (Verlag)
978-1-60327-467-8 (ISBN)
Fractures in the Elderly: A Guide to Practical Management provides geriatricians and other medical specialists who provide care for older adults with the vital guidance and most current data and opinions regarding the treatment of elderly patients who sustain a variety of fractures. It also provides orthopedic surgeons with the necessary information and most current data and opinions regarding assessment and management of geriatric conditions that predispose the elderly to fracture, perioperative complications and subsequent functional decline. Each chapter is both readable and appealing not only to geriatricians and orthopedic surgeons but to all clinicians that have contact with elderly patients who have sustained or are at high risk of sustaining a fracture. Emphasis is placed on the fact that although in some cases pre- and post-operative care in elderly fracture patient may proceed as it does in younger individuals, often there are considerations owing to functional status, pre-existing conditions, and age-related physiological declines that require specialized knowledge and alternative approaches. Developed by a group of renowned experts, Fractures in the Elderly: A Guide to Practical Management is a major addition to the literature and provides a wealth of specialized knowledge and approaches to care. It is an essential reference for all clinicians who care for older adults as well as fellows and residents in training.
Preface 6
Contents 8
Contributors 10
Part I: The Aging of Bone and Etiologies of Fractures 14
Chapter 1: Osteobiology of Aging 15
1.1 Introduction 15
1.2 Basic Anatomy of Bone 16
1.2.1 Bony Matrix 16
1.2.2 Cortical Bone 16
1.2.3 Trabecular Bone 17
1.3 Basic Multicellular Units 17
1.3.1 Osteoclasts 18
1.3.2 Osteoblasts 18
1.3.2.1 Osteoblast Versus Adipocyte Differentiation 21
1.3.3 Osteocytes 22
1.4 Bone as a Mineral Reservoir 22
1.5 Skeletal Maintenance and Remodeling 23
1.5.1 Activation (Phase 1) 23
1.5.1.1 Osteoprotegerin/RANK/RANKL 23
1.5.2 Resorption (Phase 2) 24
1.5.3 Reversal (Phase 3) 24
1.5.4 Formation (Phase 4) 25
1.6 Regulation of Bone Remodeling 26
1.6.1 Vitamin D and Osteomalacia 26
1.6.1.1 Vitamin D and Aging 26
1.6.1.2 Vitamin D-Related Myopathy 27
1.6.1.3 Vitamin D and Risk of Falls and Fracture 27
1.6.2 Parathyroid Hormone and Secondary Hyperparathyroidism 27
1.6.3 Gonadal Hormones 28
1.6.4 Thyroid Hormone 29
1.6.5 Growth Hormone/Insulin-Like Growth Factors 29
1.6.6 Interleukins 30
1.6.7 Calcitonin 30
1.6.8 Fibroblast Growth Factors and Transforming Growth Factor-b 30
1.7 The Pathophysiology of Bone Loss in the Elderly 31
1.7.1 Age-Related Bone Loss 31
1.7.2 Postmenopausal Osteoporosis 32
1.7.3 Somatopause 33
1.7.4 Androgen Decline in the Aging Male Syndrome and Andropause 34
1.7.5 Renal Osteodystrophy 35
1.7.6 Skeletal Unloading/Immobilization 36
1.7.7 Tobacco- and Alcohol-Related Bone Loss 37
1.7.8 Drug-Induced Osteoporosis 38
1.7.8.1 Glucocorticoid-Induced Osteoporosis 39
1.8 Cellular Senescence 40
1.8.1 Telomere Shortening and Telomerase Dysfunction in Aging Bone 42
References 42
Chapter 2: Pathologic Fractures 55
2.1 Introduction 55
2.2 Metastatic Tumors of Bone 56
2.2.1 Location 56
2.2.2 Presentation 56
2.2.3 Diagnostic Laboratory Tests 57
2.2.4 Imaging 57
2.2.5 Management Options 59
2.2.5.1 Medical/Radiation Therapy 59
2.2.5.2 Surgery 60
Indications 60
Treatment Options 61
Postoperative Care 61
2.3 Multiple Myeloma 63
2.3.1 Presentation 63
2.3.2 Diagnostic Laboratory Tests 63
2.3.3 Imaging 63
2.3.4 Management Options 64
2.3.4.1 Medical Therapy 64
2.3.4.2 Surgery 64
Surgical Treatment Options 64
Postoperative 65
References 65
Chapter 3: Falls 66
3.1 Introduction 66
3.2 Epidemiology 67
3.3 Risk Factors and Screening 67
3.4 Fall Assessment 68
3.4.1 Post-fall Assessment and Evaluation 68
3.4.1.1 First Fall 68
3.4.1.2 Recurrent Falls 69
3.5 Fall Prevention 70
3.5.1 Primary Prevention 70
3.5.1.1 Exercise 70
3.5.1.2 Importance of Vitamin D 71
3.5.1.3 Sarcopenia and Nutrition 72
3.5.2 Secondary Prevention 73
3.5.2.1 Technological Devices 74
3.5.2.2 Hip Protectors 74
3.5.2.3 Post-fall Interventions 74
3.5.2.4 Community-based Older Adults 75
3.5.2.5 Facility-based Older Adults 76
3.5.2.6 Inpatient-Based Older Adult 76
3.5.3 Tertiary Prevention 77
References 77
Part II: Perioperative Management 80
Chapter 4: Preoperative Assessment of Risk 81
4.1 Introduction 82
4.2 Risk Factors 83
4.3 Risk Stratification 84
4.4 Preoperative Cardiac Evaluation 84
4.5 Preoperative Pulmonary Evaluation 86
4.6 Infection and Perioperative Antibiotics 87
4.7 Thromoembolic Risk 87
4.8 Gastrointestinal Risks and Obesity 88
4.9 Nutritional Risks 88
4.10 Renal and Urological Complications 90
4.11 Perioperative Management of Diabetes Mellitus 91
4.12 Neurological Risk 91
4.13 Assessment of Functional Status 92
4.14 Unnecessary Preoperative Testing 93
References 94
Chapter 5: Anticoagulation 97
5.1 Introduction 97
5.2 Pharmacologic Methods of Prophylaxis 98
5.2.1 Aspirin 98
5.2.2 Vitamin K Antagonists (Warfarin) 100
5.2.3 Heparins 101
5.2.4 Fondaparinux 103
5.3 Timing and Duration of Prophylaxis 104
5.4 Risks of Anticoagulation 104
5.4.1 Heparin-Induced Thrombocytopenia 105
5.5 Nonpharmacologic Methods of Prophylaxis 105
5.5.1 Inferior Vena Caval Filters 107
References 108
Chapter 6: Prevention and Management of Perioperative Delirium 111
6.1 Background 111
6.1.1 Significance of Delirium in Elderly Patients with Fractures 111
6.1.2 Recognizing Delirium 113
6.1.3 Causes of Delirium 114
6.1.4 Risk Factors for Delirium 116
6.1.4.1 Medications 116
6.1.4.2 Multifactorial Risk Factor Assessment 116
6.2 Evaluation of the Patient 117
6.2.1 History Taking 117
6.2.2 Physical Examination 118
6.2.2.1 General Examination 118
6.2.3 Mental Status Testing 118
6.2.4 Preoperative Ancillary Tests 119
6.3 Preventing and Managing Delirium 120
6.3.1 General 120
6.3.2 Nonpharmacologic management 121
6.3.3 Pain Control 122
6.4 Pharmacologic Treatment of Delirium 122
References 123
Chapter 7: Anesthesia and Postoperative Pain Control 125
7.1 Introduction 126
7.2 Physiologic Changes that Influence Anesthesia in the Elderly 128
7.2.1 Cardiac Changes with Age 128
7.2.2 Pulmonary Changes with Age 128
7.2.3 Autonomic Nervous System Changes with Age 129
7.2.4 Renal, Hepatic, and Pharmacologic Changes with Age 129
7.2.5 Neurologic Changes 131
7.3 Preoperative Evaluation 132
7.4 Intraoperative Period 133
7.4.1 Introduction 133
7.4.2 Regional vs. General Anesthesia 134
7.4.3 General Anesthesia in Older Adults with Fractures 134
7.4.4 Regional Anesthesia in Older Adults with Fractures 135
7.5 Postoperative Care and Analgesia 138
7.5.1 General Principles of Analgesia 138
7.5.2 Systemic Analgesia 139
7.5.3 Regional Analgesia 141
7.5.4 Recommendations for Postoperative Analgesia 142
7.5.5 Preemptive Analgesia 143
7.5.6 Postoperative Cognitive Dysfunction 144
References 145
Chapter 8: Postoperative Complications 154
8.1 Cardiac Complications 154
8.2 Anemia, Bleeding, and Hematoma 156
8.3 Falls 157
8.4 Electrolyte Imbalances, Fluctuating Volume Status, and Nutritional Considerations 159
8.4.1 Hyponatremia 159
8.4.2 Hypernatremia 160
8.4.3 Potassium Imbalance 160
8.4.4 Imbalances in Calcium and Other Electrolytes 161
8.4.5 Nutrition 161
8.5 Infections: Surgical Site Infection, Urinary Tract Infection, and Pneumonia 162
8.5.1 Surgical Site Infection 162
8.5.2 Pulmonary Complications: Pneumonia 162
8.5.3 Urinary Tract Infection 163
8.6 Pressure Ulcers 164
8.7 Pain Management 165
8.8 Deep Vein Thrombosis, Pulmonary Embolism, and Fat Embolism 166
8.8.1 Deep Vein Thrombosis 166
8.8.2 Pulmonary Embolism 166
8.8.3 Fat Embolism 169
8.9 Postoperative Cognitive Dysfunction: Delirium 170
References 170
Part III: Common Fractures in the Elderly 178
Chapter 9: Hand and Wrist Fractures in the Elderly 179
9.1 Basic Anatomy 180
9.1.1 Carpus 180
9.2 Phalangeal and Metacarpal Structures 181
9.3 Basic Physical Examination 182
9.4 Common Fractures and Their Management 182
9.4.1 Distal Radius Fractures 182
9.4.2 Carpus 183
9.4.3 Phalangeal Fractures 185
9.4.4 Metacarpal Fractures 186
9.5 Operative Fixation 188
9.6 Perioperative Management 190
9.7 Rehabilitation 190
9.8 Prevention 192
References 193
Chapter 10: Fractures of the Shoulder and Elbow 194
10.1 Proximal Humerus Fractures 194
10.1.1 Background and Epidemiology 194
10.1.2 Anatomy and Fracture Pattern 195
10.1.2.1 Anatomy 195
10.1.2.2 Fracture Pattern 197
10.1.3 Initial Presentation and Evaluation 197
10.1.4 Nonoperative Treatment 199
10.1.5 Operative Management 200
10.1.6 Rehabilitation 203
10.2 Fractures of the Humeral Shaft 204
10.2.1 Background and Epidemiology 204
10.2.2 Anatomy and Fracture Pattern 204
10.2.2.1 Anatomy 204
10.2.3 Classification 205
10.2.4 Initial Presentation and Evaluation 205
10.2.5 Nonoperative Management 205
10.2.6 Operative Treatment 207
10.2.7 Rehabilitation 209
10.3 Distal Humerus Fractures 209
10.3.1 Background 209
10.3.2 Anatomy and Fracture Pattern 210
10.3.2.1 Anatomy 210
10.3.3 Fracture Pattern 211
10.3.4 Initial Presentation and Evaluation 211
10.3.4.1 Mechanism 211
10.3.5 History and Physical Examination 211
10.3.5.1 Radiographs 212
10.3.6 Nonoperative Management 212
10.3.7 Operative Management 212
10.3.8 Rehabilitation 214
10.3.9 Outcomes and Complications 215
10.3.9.1 Outcomes 215
10.3.9.2 Complications 215
10.4 Radial Head Fractures 215
10.4.1 Background and Epidemiology 215
10.4.2 Anatomy and Classification 216
10.4.2.1 Anatomy and Biomechanics 216
10.4.2.2 Classification 216
10.4.3 Initial Presentation and Evaluation 217
10.4.3.1 History and Physical Examination 217
10.4.3.2 Radiographs 217
10.4.4 Management 218
10.4.4.1 Nonoperative Management 218
10.4.4.2 Operative Management 218
10.4.4.3 Open Reduction and Internal Fixation 218
10.4.4.4 Excision 219
10.4.5 Radial Head Replacement 219
10.4.6 Rehabilitation 220
10.4.7 Complications 221
10.5 Olecranon Fractures 221
10.5.1 Background 221
10.5.2 Anatomy and Fracture Patterns 221
10.5.2.1 Anatomy 221
10.5.2.2 Classification 222
10.5.3 Initial Presentation and Evaluation 222
10.5.3.1 Mechanism 222
10.5.3.2 History and Physical Examination 222
10.5.3.3 Radiographs 223
10.5.4 Management 223
10.5.4.1 Type I Injuries 224
10.5.4.2 Type II Injuries 224
10.5.4.3 Type III Injuries 225
10.5.5 Rehabilitation 225
10.5.6 Outcomes and Complications 225
10.6 Summary 226
References 226
Chapter 11: Vertebral Compression Fractures 231
11.1 Introduction 231
11.2 Biomechanics/Anatomy 232
11.3 Pathogenesis 233
11.4 Clinical Presentation 234
11.5 Radiology 235
11.6 Management 237
11.7 Surgical management 239
11.8 Conclusion 240
References 241
Chapter 12: Hip Fractures 244
12.1 Epidemiology 244
12.2 Evaluation 245
12.3 Fracture Pattern 246
12.4 Treatment options 247
12.4.1 Non-operative Treatment 247
12.4.2 Operative treatment 248
12.4.2.1 Operative Treatment of Femoral Neck Fractures 249
Percutaneous Screw Fixation 249
Arthroplasty 250
12.4.2.2 Operative Treatment of Intertrochanteric Fractures 252
Sliding Hip Screw 252
Intramedullary Hip Screw 254
Blade Plate 255
External Fixation 255
12.4.2.3 Operative Treatment of Subtrochanteric Fractures 255
12.5 Functional Rehabilitation 256
12.6 Prevention 257
12.7 Conclusion 258
References 259
Chapter 13: Fractures of the Distal Femur 262
13.1 Introduction 262
13.2 Epidemiology 263
13.3 Pre-operative Assessment 263
13.3.1 History 263
13.3.2 Physical Examination 264
13.3.3 Radiographic Imaging 264
13.3.4 Medical Assessment 265
13.4 Treatment 265
13.4.1 Non-operative Treatment 266
13.4.2 Operative Treatment 266
13.4.2.1 Indications and Goals 266
13.4.2.2 Antegrade Intramedullary Nailing 266
13.4.2.3 Retrograde Intramedullary Nailing 267
13.4.2.4 Lateral Femoral Plating 267
13.4.2.5 Fixed Angle Devices and Locking Plates 268
13.4.2.6 Total Knee Arthroplasty 269
13.4.2.7 Treatment of Distal Femur Periprosthetic Fractures 269
13.4.2.8 Summary of Operative Intervention 270
13.5 Complications 271
13.6 Functional Outcomes 272
13.7 Rehabilitation 272
References 272
Chapter 14: Tibial Plateau Fractures in the Elderly 274
14.1 Introduction 274
14.2 Anatomy 275
14.3 Diagnosis 276
14.4 Classification 277
14.5 Treatment 278
14.5.1 Surgical Fixation 279
14.5.1.1 Pre-operative Planning 279
14.5.1.2 Surgical Anatomy and Approaches 280
14.5.1.3 Alternative Methods of Surgical Fixation 281
14.6 Outcomes 283
14.7 Conclusions 285
References 285
Part IV: Rehabilitation, Post-fracture Evaluation,and Prevention 288
Chapter 15: Rehabilitation 289
15.1 Introduction 289
15.2 Consequences of Injury 290
15.3 Barriers to Rehabilitation 290
15.3.1 Thromboembolic Complications 291
15.3.2 Decubitus Ulcers 291
15.3.3 Pneumonia 291
15.3.4 Loss of Joint Range of Motion 292
15.3.5 Acceleration of Degenerative Joint Disease 292
15.3.6 Delirium 292
15.3.7 Loss of Strength 293
15.3.8 Cardiopulmonary Deconditioning 293
15.3.9 Bowel and Bladder Incontinence 293
15.3.10 Pain Control 294
15.3.11 Weight-Bearing Status 294
15.3.12 Neurologic Compromise 295
15.3.13 Vascular Insufficiency and Diabetes 295
15.3.14 Vision or Hearing Problems 296
15.4 Goals of Rehabilitation 296
15.5 Common Fractures 297
15.5.1 Upper Extremity Fractures/Dislocations 297
15.5.1.1 Proximal Humerus 297
15.5.1.2 Shoulder Dislocation 298
15.5.1.3 Fractures About the Elbow 299
15.5.1.4 Forearm, Wrist, and Hand Fractures 299
15.5.2 Spine Fractures 300
15.5.2.1 Stable Spinal Fractures 300
15.5.2.2 Unstable Fractures 301
15.5.3 Lower Extremity Fractures 301
15.5.3.1 Pelvis Fractures 301
15.5.3.2 Hip Fractures 302
15.5.3.3 Distal Femur 303
15.5.3.4 Tibia, Ankle, and Foot Fractures 304
15.6 Polytrauma 304
15.7 Acute Care Hospital 305
15.7.1 Team Approach 305
15.7.2 Optimization of Pain Control 306
15.7.3 Evaluation of Physical Capabilities 307
15.8 Follow-Up Care 308
15.9 Nursing Home Care 309
15.10 Skilled Nursing Facility 309
15.11 Acute Rehabilitation 309
15.12 Home and Beyond 310
15.13 Conclusion 310
References 310
Chapter 16: Evaluation of Bone Fragility and Fracture Prevention 312
16.1 Introduction 312
16.2 General Approach to Evaluating Patients with Osteoporotic Fractures 313
16.2.1 Skeletal History 313
16.2.2 Risk Factor Assessment 313
16.2.2.1 Personal Risk Factors 314
16.2.2.2 Medical Conditions 315
16.2.2.3 Medications 315
16.3 Physical Exam 316
16.3.1 Detection of Vertebral Fractures and Occult Nonvertebral Fractures 316
16.3.2 Secondary Medical Causes of Bone Loss 317
16.3.3 Assessment of Fall Risk 317
16.4 Laboratory Testing 317
16.5 Bone Mineral Density Testing 318
16.6 Treatments and Prevention 319
16.6.1 Fragility Fracture Clinical Pathways 319
16.6.2 Calcium, Vitamin D, and Nutritional Considerations 321
16.6.3 Bisphosphonates 322
16.6.4 Estrogens and Selective Estrogen Receptor Modulators 323
16.6.5 Teriparatide and Other PTH Analogues 324
16.6.6 Physical Activity and Exercise 324
16.6.7 Prevention 325
References 326
Index 332
| Erscheint lt. Verlag | 25.11.2010 |
|---|---|
| Reihe/Serie | Aging Medicine | Aging Medicine |
| Zusatzinfo | XII, 335 p. |
| Verlagsort | Totowa |
| Sprache | englisch |
| Themenwelt | Medizinische Fachgebiete ► Chirurgie ► Unfallchirurgie / Orthopädie |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Geriatrie | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Orthopädie | |
| Medizin / Pharmazie ► Pflege | |
| ISBN-10 | 1-60327-467-7 / 1603274677 |
| ISBN-13 | 978-1-60327-467-8 / 9781603274678 |
| Haben Sie eine Frage zum Produkt? |
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