Geriatric proximal femur fracture updates

Abstract

Proximal femur fractures in the aging population present a variety of challenges. Physiologically, patients incurring this fracture are typically frail, with significant medical comorbidities, yet require early surgical treatment to restore mobility to prevent deterioration. Socioeconomically, the occurrence of a fragility fracture may be the beginning of the loss of independence, and the burdens of rehabilitation and support are borne by the individual patient and health care systems.

Keywords: geriatric fracture; hip fracture; proximal femur.

Figure 1.

A, AP radiographic view of the right hip and coronal, sagittal, and axial computed tomographic views showing the femur displaced into varus and retroversion of a 70-year-old male patient, who sustained a displaced right femoral neck fracture after falling from a sitting position. B, AP and Lauenstein radiographic views after 6-year follow-up of hybrid THA (cemented stem, non-cemented acetabular cup). Harris Hip Score of 93.

Figure 2.

A, AP and Lequesne-DeSéze false profile radiographic views of the right hip of an 85-year-old healthly (<2 comorbidities) female patient, who sustained a displaced right intertrochanteric hip fracture after falling to the ground. B, After a fascia iliac block, AP radiographic view of the right hip with traction and internal rotation was performed. C, Immediate postoperative AP and Lauenstein radiographic views of the right hip. Despite the adequate reduction, note that the cephalic screw is slightly superior. D, AP and Lauenstein radiographic views of the right hip after 45 days show screw cut-out. Femoral head was judged adequate for a reosteosynthesis. E, Immediate AP and Lauenstein radiographic views of the right hip after reosteosynthesis with a long augmented cephalomedullary nail. Small arrows show bone cement filling also the area of the cut-out at the femoral head. F, Clinical intraoperative photograph demonstrating the insertion of the bone cement for augmentation. G, Clinical immediate postoperative photographs of the patient during physical therapy protocol. H, AP and Lauenstein radiographic views of the right hip after 1 year demonstrating adequate fracture healing, with mild heterotopic ossification (Brooker et al grade 3). Harris hip score of 80.

Figure 3.

Templating and configuration of SIGN hip construct. A, Template. B, Final Construct.

Figure 4.

SIGN hip constructs.

Figure 5.

A, Comparison with national benchmark and funnel plot for delirium care. B, Living status locally (top bar) and national benchmark (bottom bar) at 3-month follow-up. C, Mobility locally (top bar) and national benchmark (bottom bar) at 3-month follow-up. Source: DICA (Dutch Institute Clinical Auditing) Dutch Hip Fracture Audit.