Osteoporosis International

, Volume 21, Supplement 4, pp 637–646

Ortho-geriatric service—a literature review comparing different models

  • C. Kammerlander
  • T. Roth
  • S. M. Friedman
  • N. Suhm
  • T. J. Luger
  • U. Kammerlander-Knauer
  • D. Krappinger
  • M. Blauth
Review

Abstract

In the fast-growing geriatric population, we are confronted with both osteoporosis, which makes fixation of fractures more and more challenging, and several comorbidities, which are most likely to cause postoperative complications. Several models of shared care for these patients are described, and the goal of our systematic literature research was to point out the differences of the individual models. A systematic electronic database search was performed, identifying articles that evaluate in a multidisciplinary approach the elderly hip fracture patients, including at least a geriatrician and an orthopedic surgeon focused on in-hospital treatment. The different investigations were categorized into four groups defined by the type of intervention. The main outcome parameters were pooled across the studies and weighted by sample size. Out of 656 potentially relevant citations, 21 could be extracted and categorized into four groups. Regarding the main outcome parameters, the group with integrated care could show the lowest in-hospital mortality rate (1.14%), the lowest length of stay (7.39 days), and the lowest mean time to surgery (1.43 days). No clear statement could be found for the medical complication rates and the activities of daily living due to their inhomogeneity when comparing the models. The review of these investigations cannot tell us the best model, but there is a trend toward more recent models using an integrated approach. Integrated care summarizes all the positive features reported in the various investigations like integration of a Geriatrician in the trauma unit, having a multidisciplinary team, prioritizing the geriatric fracture patients, and developing guidelines for the patients’ treatment. Each hospital implementing a special model for geriatric hip fracture patients should collect detailed data about the patients, process of care, and outcomes to be able to participate in audit processes and avoid peerlessness.

Keywords

Co-management Fragility fracture management Geriatric fracture center Systematic literature review 

Abbreviations

ADL

Activities of daily living

IADS

Instrumental activities of daily living

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • C. Kammerlander
    • 1
  • T. Roth
    • 1
  • S. M. Friedman
    • 2
  • N. Suhm
    • 3
  • T. J. Luger
    • 4
  • U. Kammerlander-Knauer
    • 4
  • D. Krappinger
    • 1
  • M. Blauth
    • 1
  1. 1.Department of Trauma Surgery and Sports MedicineMedical University of InnsbruckInnsbruckAustria
  2. 2.Department of MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA
  3. 3.Treatment Centre for Musculoskeletal DiseasesUniversity Hospital of BaselBaselSwitzerland
  4. 4.Department of Anaesthesiology and Critical Care MedicineMedical University InnsbruckInnsbruckAustria

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