This AOA symposium paper by Koval et al. reviews the principles governing fracture management in elderly patients. It covers how patient factors (comorbidities, cognition, functional baseline), bone quality, soft-tissue status, and specific injury patterns shape surgical decision-making. The paper synthesizes existing evidence and identifies where additional research is needed.
Every elderly fracture patient you see represents a compounding problem: the fracture itself is just one layer on top of osteopenia, comorbidities, nutritional deficits, and cognitive limitations that all modify the treatment plan.
The operative timing data should change how you think about the preoperative workup. Get elderly hip fracture patients to the OR within 48 hours — but do not rush a patient with multiple active comorbidities into surgery before they are medically optimized. The 24-hour threshold improves survival only in patients with fewer than three comorbidities; in sicker patients, the extra time for optimization saves lives.
When you see a fragility fracture (wrist, hip, vertebra, proximal humerus), recognize that you are often the first physician to identify undertreated osteoporosis. Initiate the workup or refer. Bisphosphonates reduce subsequent fracture risk, and most of these patients will never receive treatment unless you act.
For periprosthetic fractures, plan fixation that bypasses the defect by at least two cortical diameters, overlap any plate-nail constructs to eliminate the stress-riser, and counsel patients that complication rates approach those of revision arthroplasty.
This AOA symposium paper by Koval et al. reviews the principles governing fracture management in elderly patients. It covers how patient factors (comorbidities, cognition, functional baseline), bone quality, soft-tissue status, and specific injury patterns shape surgical decision-making. The paper synthesizes existing evidence and identifies where additional research is needed.
Every elderly fracture patient you see represents a compounding problem: the fracture itself is just one layer on top of osteopenia, comorbidities, nutritional deficits, and cognitive limitations that all modify the treatment plan.
The operative timing data should change how you think about the preoperative workup. Get elderly hip fracture patients to the OR within 48 hours — but do not rush a patient with multiple active comorbidities into surgery before they are medically optimized. The 24-hour threshold improves survival only in patients with fewer than three comorbidities; in sicker patients, the extra time for optimization saves lives.
When you see a fragility fracture (wrist, hip, vertebra, proximal humerus), recognize that you are often the first physician to identify undertreated osteoporosis. Initiate the workup or refer. Bisphosphonates reduce subsequent fracture risk, and most of these patients will never receive treatment unless you act.
For periprosthetic fractures, plan fixation that bypasses the defect by at least two cortical diameters, overlap any plate-nail constructs to eliminate the stress-riser, and counsel patients that complication rates approach those of revision arthroplasty.