Geriatric Long Bone Fractures

  • Jessica G. Kingsberg
  • Daniel T. Altman


Long bone fractures in the elderly are uncommon. According to a retrospective database review performed by Keller et al. [1], fractures of the ribs, distal radius, pelvic ring, facial bones, proximal humerus, clavicle, ankle, and sacrum were the most common fractures in patients over age 65. Although uncommon, fractures of the tibial and femoral diaphysis can have devastating functional effects on elderly patients and have increased rates of morbidity and mortality compared to equivalent fractures in younger patients [2]. Schatzker et al. [3] in their 1974 review of 68 patients with distal femur fractures recommended cast treatment for all elderly patients with easily reducible fractures and described using internal fixation in patients with osteoporosis due to the risks of implant failure, malunion, and nonunion. Since that time, treatment of elderly patients with diaphyseal fractures of the tibia and femur has changed dramatically. That being said, as is the case with all implants in osteoporotic bone, true fixation may be difficult without supplemental fixation. Treatment depends on the patient’s overall functional status with the goal of early mobilization and pain control.


  1. 1.
    Keller JM, et al. Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma. 2012;26(9):e161–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Enninghorst N, et al. Population-based epidemiology of femur shaft fractures. J Trauma Acute Care Surg. 2013;74(6):1516–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Schatzker J, Horne G, Waddell J. The Toronto experience with the supracondylar fracture of the femur, 1966–1972. Injury. 1974;6(2):113–28.CrossRefPubMedGoogle Scholar
  4. 4.
    Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma Acute Care Surg. 2001;50(1):116–9.CrossRefGoogle Scholar
  5. 5.
    Sadro CT, et al. Geriatric trauma: a radiologist’s guide to imaging trauma patients aged 65 years and older. Radiographics. 2015;35(4):1263–85.CrossRefPubMedGoogle Scholar
  6. 6.
    Salminen S, et al. Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma Acute Care Surg. 1997;43(1):117–22.CrossRefGoogle Scholar
  7. 7.
    Cummings SR, et al. Risk factors for hip fracture in white women. N Engl J Med. 1995;332(12):767–74.CrossRefPubMedGoogle Scholar
  8. 8.
    Tinubu J, Scalea TM. Management of fractures in a geriatric surgical patient. Surg Clin N Am. 2015;95(1):115–28.CrossRefPubMedGoogle Scholar
  9. 9.
    Bernstein J, et al. Preoperative testing for hip fracture patients delays surgery, prolongs hospital stays, and rarely dictates care. J Orthop Trauma. 2016;30(2):78–80.CrossRefPubMedGoogle Scholar
  10. 10.
    Marcantonio A, et al. The clinical and economic impact of preoperative transthoracic echocardiography in elderly patients with hip fractures. Bull Hosp Joint Dis. 2015;73(4):239–42.Google Scholar
  11. 11.
    Naylor MD, et al. Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults. J Comp Eff Res. 2014;3(3):245–57.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Umei N, et al. Impact of mobilisation therapy on the haemodynamic and respiratory status of elderly intubated patients in an intensive care unit: a retrospective analysis. Intensive Crit Care Nurs. 2016;35:16–21.CrossRefPubMedGoogle Scholar
  13. 13.
    Al-Nuaimi Y, Sherratt MJ, Griffiths CEM. Skin health in older age. Maturitas. 2014;79(3):256–64.CrossRefPubMedGoogle Scholar
  14. 14.
    Johnson KD, Cadambi A, Burton Seibert G. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma Acute Care Surg. 1985;25(5):375–84.CrossRefGoogle Scholar
  15. 15.
    Seibel R, Border JR, et al. Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg. 1985;202(3):283.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bone LB, et al. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71(3):336–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Andruszkow H, et al. External fixation in the elderly. Injury. 2015;46:S7–S12.CrossRefPubMedGoogle Scholar
  18. 18.
    Seebeck J, et al. Effect of cortical thickness and cancellous bone density on the holding strength of internal fixator screws. J Orthop Res. 2004;22(6):1237–42.CrossRefPubMedGoogle Scholar
  19. 19.
    Patel KV, et al. High-energy femur fractures increase morbidity but not mortality in elderly patients. Clin Orthop Relat Res. 2014;472(3):1030–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Cantu RV, Graves SC, Spratt KF. In-hospital mortality from femoral shaft fracture depends on the initial delay to fracture fixation and injury severity score-a retrospective cohort study from the NTDB 2002–2006. J Trauma Acute Care Surg. 2014;76(6):1433.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Tuttle MS, et al. Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient. J Trauma Acute Care Surg. 2009;67(3):602–5.CrossRefGoogle Scholar
  22. 22.
    Nowotarski PJ, et al. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000;82(6):781–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Seligson D, et al. Plating of femoral shaft fractures. A review of 15 cases. injury. 2001;14:17.Google Scholar
  24. 24.
    Nayak RM, et al. Minimally invasive plate osteosynthesis using a locking compression plate for distal femoral fractures. J Orthop Surg. 2011;19(2):185.CrossRefGoogle Scholar
  25. 25.
    Watson JT, Moed BR. Ipsilateral femoral neck and shaft fractures: complications and their treatment. Clin Orthop Relat Res. 2002;399:78–86.CrossRefGoogle Scholar
  26. 26.
    Khursheed O, et al. Results of treatment of distal extra: articular femur fractures with locking plates using minimally invasive approach—experience with 25 consecutive geriatric patients. Musculoskelet Surg. 2015;99(2):139–47.CrossRefPubMedGoogle Scholar
  27. 27.
    Fankhauser F, et al. Minimal-invasive treatment of distal femoral fractures with the LISS (Less Invasive Stabilization System): a prospective study of 30 fractures with a follow up of 20 months. Acta Orthop Scand. 2004;75(1):56–60.CrossRefPubMedGoogle Scholar
  28. 28.
    Dunlop DG, Brenkel IJ. The supracondylar intramedullary nail in elderly patients with distal femoral fractures. Injury. 1999;30:475–84.CrossRefPubMedGoogle Scholar
  29. 29.
    Wähnert D, et al. Long-term stability of angle-stable versus conventional locked intramedullary nails in distal tibia fractures. BMC Musculoskelet Disord. 2013;14(1):1.CrossRefGoogle Scholar
  30. 30.
    Yoon RS, et al. Outcomes following combined intramedullary nail and plate fixation for complex tibia fractures: a multi-centre study. Injury. 2015;46(6):1097–101.CrossRefPubMedGoogle Scholar
  31. 31.
    Meneghini RM, et al. Modern retrograde intramedullary nails versus periarticular locked plates for supracondylar femur fractures after total knee arthroplasty. J Arthroplast. 2014;29(7):1478–81.CrossRefGoogle Scholar
  32. 32.
    Neubauer T, et al. Retrograde femoral nailing in elderly patients: outcome and functional results. Orthopedics. 2012;35(6):e855–61.CrossRefPubMedGoogle Scholar
  33. 33.
    Bliemel C, et al. Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model. Arch Orthop Trauma Surg. 2015;135(1):49–58.CrossRefPubMedGoogle Scholar
  34. 34.
    Clement ND, et al. The outcome of tibial diaphyseal fractures in the elderly. Bone Joint J. 2013;95(9):1255–62.CrossRefPubMedGoogle Scholar
  35. 35.
    Ritchie AJ, et al. Type III tibial fractures in the elderly: results of 23 fractures in 20 patients. Injury. 1991;22(4):267–70.CrossRefPubMedGoogle Scholar
  36. 36.
    McBirnie J. The epidemiology of tibial fractures. Bone Joint J. 1995;77(3):417–21.Google Scholar
  37. 37.
    Schmidt AH, Finkemeier CG, Tornetta P. Treatment of closed tibial fractures. J Bone Joint Surg Am. 2003;85(2):352–68.CrossRefGoogle Scholar
  38. 38.
    Coles CP, Gross M. Closed tibial shaft fractures: management and treatment complications. A review of the prospective literature. Can J Surg. 2000;43(4):256.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Lau TW, et al. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008;32(5):697–703.CrossRefPubMedGoogle Scholar
  40. 40.
    Finkemeier CG, et al. A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma. 2000;14(3):187–93.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Silver State OrthopedicsLas VegasUSA
  2. 2.Allegheny Health NetworkDrexel University College of MedicinePhiladelphiaUSA

Personalised recommendations