What is the most common orthopedic presentation in patients (pts) 65 years and older?

Hip Fractures are the Most Common Orthopedic Presentation in Patients 65 Years and Older

Hip fractures represent the most common orthopedic presentation in patients 65 years and older, accounting for approximately 43.7% of all osteoporotic fractures in this age group. 1

Epidemiology of Fragility Fractures in Older Adults

• Fragility fractures are a major public health problem with significant impact on quality of life for patients and their families 2
• Approximately 325,000 hip fractures occur annually in the United States, with a mean age of 77 years 2
• The gender distribution shows a female predominance with a male-to-female ratio of 1:3.1 1
• Hip fractures are associated with excess short-term and long-term all-cause mortality, with mortality in the first year three times higher than expected in the general geriatric population 2

Distribution of Fracture Sites in Patients Over 65

• Hip fractures: 43.7% (most common presentation) 1
• Vertebral compression fractures: 25.3% 1
• Distal radius and ulna fractures: 13.2% 1
• Proximal humerus fractures: 10.9% 1
• Other fractures: 7.0% 1

Risk Factors and Causes

• Falls are the primary mechanism of injury, accounting for 71.6% of fractures 1
• Most fractures (65.6%) occur at home 1
• Osteoporosis is the most common underlying cause of fragility fractures 2
• Age-related factors including decreased bone mineral density, impaired balance, and reduced muscle strength contribute to fracture risk 2

Management Considerations

• Fragility fractures should be managed in a multidisciplinary clinical system with adequate preoperative assessment, pain relief, appropriate fluid management, and surgery within 48 hours of injury 2
• Orthogeriatric comanagement significantly improves functional outcomes, reduces length of hospital stay, and decreases mortality 2
• Early surgery (within 24-48 hours) significantly reduces short-term and mid-term mortality rates and reduces medical complications due to immobility 2
• Systematic evaluation for future fracture risk should be performed in all patients over 50 years with a recent fracture 2

Treatment Approaches

Hip Fractures

• Stable non-displaced femoral neck fractures can be addressed with cannulated fixation 2
• Displaced femoral neck fractures in healthy, active older individuals are best treated by total hip replacement 2
• In frail patients, hemiarthroplasty is often preferred due to shorter operative time and lower dislocation risk 2
• For stable intertrochanteric fractures, a sliding hip screw is favored; unstable intertrochanteric fractures are treated with an antegrade cephalomedullary nail 2

Other Common Fractures

• Most proximal humeral fractures can be treated non-operatively with good functional outcomes 2
• Distal radius fractures can be treated by cast immobilization or operative methods including locking plates, Kirschner wires, or external fixation 2

Rehabilitation and Secondary Prevention

• An appropriate rehabilitation program should include early post-fracture physical training, muscle strengthening, and long-term balance training 2
• Secondary fracture prevention is critical, as the refracture rate is approximately 25.6% within three years after surgery 1
• Pharmacological treatment should use medications demonstrated to reduce vertebral, non-vertebral, and hip fracture risk 2

Clinical Pitfalls to Avoid

• Delay in surgical intervention beyond 48 hours increases mortality risk and complications 2
• Failure to assess for osteoporosis can lead to missed diagnoses, as studies show that 23% of patients with end-stage osteoarthritis also have osteoporosis 3
• Inadequate pain management can delay mobilization and rehabilitation 2
• Overlooking the need for secondary fracture prevention increases the risk of subsequent fractures 2
• Underutilization of anti-osteoporotic medications is common, with only 12.3% of patients receiving regular treatment after fracture 1