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Open Fractures in the Elderly

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Senior Trauma Patients

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Abstract

As the global population of elderly people rises, the number of elderly patients sustaining both low- and high-energy fractures also rises. While management of open fractures in the elderly is similar to that in younger patients, there are several unique factors to consider. Elderly patients may have more tenuous soft-tissue envelopes and decreased bone density due to changes associated with aging. These changes can make coverage and healing of open injuries more challenging. While there is little evidence specifically on open fractures in the elderly, there are some reports that suggest higher complication, nonunion, and mortality rates in these patients. As such, we recommend thoughtful preoperative medical resuscitation and optimization with the early involvement of our medicine and geriatrics colleagues. Prophylactic antibiotics should be administered on presentation for 24 h or until soft-tissue coverage. Urgent debridement with primary closure or early soft-tissue coverage and definitive fixation should be performed as soon as possible to allow for early mobilization. Venous thromboembolism prophylaxis should be administered for 35 days and early involvement of our osteoporosis management team is advised. We also recommend close clinical and radiographic follow-up to monitor bony and soft-tissue healing after elderly open fractures.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Prisma Health-Upstate, Greenville, SC, USA

    Erin Pichiotino, Dylan Nugent & Kyle J. Jeray

  2. University of South Carolina School of Medicine Greenville, Greenville, SC, USA

    Kyle J. Jeray

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  1. Erin Pichiotino
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Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zurich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA

    Stephen L. Kates

  3. Department of Trauma Surgery, University Hospital Zurich, Zürich, Switzerland

    Christian Hierholzer

  4. Department of Aging Medicine and Aging Research, City Hospital Zurich-Waid Zurich University, Zürich, Switzerland

    Heike A. Bischoff-Ferrari

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Pichiotino, E., Nugent, D., Jeray, K.J. (2022). Open Fractures in the Elderly. In: Pape, HC., Kates, S.L., Hierholzer, C., Bischoff-Ferrari, H.A. (eds) Senior Trauma Patients . Springer, Cham. https://doi.org/10.1007/978-3-030-91483-7_30

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