Musculoskeletal Trauma in the Elderly, 1st Edition
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Musculoskeletal
Trauma
in the Elderly
Musculoskeletal
Trauma
in the Elderly
Edited by
Charles M Court-Brown, MD, FRCSEd(Orth)
University of Edinburgh, UK
Margaret M McQueen, MD, FRCSEd(Orth)
University of Edinburgh, UK
Marc F Swiontkowski, MD
University of Minnesota Minneapolis, MN, USA
David Ring MD, PhD
Dell Medical School, The University of Texas at Austin, USA
Susan M Friedman MD, MPH
University of Rochester School of Medicine and Dentistry, USA
Andrew D Duckworth, MSc, PhD,
FRCSEd(Tr&Orth)
Edinburgh Orthopaedic Trauma Unit and University of Edinburgh, UK
CRC Press
Taylor & Francis Group
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© 2017 by Taylor & Francis Group, LLC
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Version Date: 20160601
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Contents
Preface
Contributors
1 Epidemiology of fractures in the elderly
Charles M. Court-Brown and Kate E. Bugler
2 Age-related changes in the elderly
Katrin Singler and Cornel Christian Sieber
3 Preoperative assessment and care of the elderly
Joseph A. Nicholas
4 The orthogeriatric team approach to the management of the elderly
Richard D. Southgate and Stephen L. Kates
5 The management of osteomyelitis
Bruce H. Ziran, Adam G. Hirschfeld and Jarrad A. Barber
6 Other orthopaedic complications
Margaret M. McQueen, Roger M. Atkins and Peter V. Giannoudis
7 Systemic complications
Houman Javedan and Samir Tulebaev
8 Rehabilitation after fracture
Patrick Kortebein
9 Outcome after fracture
Susan M. Friedman
10 Osteoporosis
Alexandra Stavrakis, Susan V. Bukata and Susan M. Friedman
11 Other bone diseases in the elderly
Stuart H. Ralston
12 Falls
Oddom Demontiero, Derek Boersma and Gustavo Duque
13 Open fractures
Lisa K. Cannada and Tina K. Dreger
14 Polytrauma in the elderly
Julie A. Switzer and Lisa K. Schroder
15 Multiple fractures
Nicholas D. Clement
16 Metastatic fractures
Wakenda K. Tyler
17 Periprosthetic fractures
Adam Sassoon and George Haidukewych
18 Scapular fractures
Jan Bartoníček
19 Clavicle fractures
Patrick D.G. Henry and Michael D. McKee
20 Proximal humeral fractures
Stig Brorson
21 Dislocations around the shoulder
Sang-Jin Shin
22 Humeral diaphyseal fractures
Amy S. Wasterlain and Kenneth A. Egol
23 Distal humeral fractures
Nathan Sacevich, George S. Athwal and Graham King
24 Proximal forearm fractures and elbow dislocations
Andrew D. Duckworth
25 Radius and ulnar diaphyseal fractures
Taylor A. Horst, David C. Ring and Jesse B. Jupiter
26 Distal radius and ulnar fractures
Margaret M. McQueen
27 Carpal fractures and dislocations
Andrew D. Duckworth
28 Metacarpal fractures
Mark Henry
29 Phalangeal fractures and dislocations
Guang Yang, Evan P. McGlinn and Kevin C. Chung
30 Cervical spine fractures
Paul A. Anderson
31 Thoracolumbar and sacral fractures
S. Rajasekaran, Rishi Mugesh Kanna, Ajoy Prasad Shetty and
Anupama Mahesh
32 Pelvic fractures
John Keating
33 Acetabular fractures
Sameer Jain and Peter V. Giannoudis
34 Intracapsular proximal femoral fractures
Kjell Matre and Jan-Erik Gjertsen
35 Extracapsular proximal femur fractures
Paul M. Lafferty
36 Femoral diaphyseal fractures
Joyce S.B. Koh and Tet Sen Howe
37 Distal femoral fractures
Eleanor Davidson and Charles M. Court-Brown
38 Patellar fractures
Olivia C. Lee and Mark S. Vrahas
39 Proximal tibial fractures
Matthew D. Karam and J. Lawrence Marsh
40 Tibia and fibula diaphyseal fractures
Leela C. Biant and Charles M. Court-Brown
41 Distal tibial fractures
Paul S. Whiting and William T. Obremskey
42 Ankle fractures
Murray D. Spruiell and Cyril Mauffrey
43 Foot fractures
Dolfi Herscovici, Jr. and Julia M. Scaduto
44 Soft tissue injuries
Nicola Maffulli, Alessio Giai Via, Eleonora Piccirilli and Francesco
Oliva
45 Sports injuries in the elderly
Marc Tompkins, Robby Sikka and David Fischer
Index
Preface
The last 20 to 30 years have seen a massive increase in the number of
fractures and other injuries in the older population. Both the fracture
morphology and overall health of the patients are very different from the
fractures and the patients who were seen and treated in the heady days of
expanding trauma systems in the 1970s and 1980s, which were developed
mainly to treat high energy trauma. We believe that it is only now that
surgeons are realizing that the techniques developed to cope with high
energy injuries are not always appropriate for the older patient. However,
there has also been a realization that high energy injuries in younger
patients and low energy injuries in older patients have a number of
similarities, the main one being that an interdisciplinary approach is
required to treat both types of patients. As a result, orthogeriatric units are
being established in many countries.
Medical literature has failed to keep pace with the rapid expansion of
musculoskeletal trauma in the older patient. Studies of fragility fractures
have concentrated mainly on proximal femoral fractures, and there is still a
belief that the only musculoskeletal problems in the elderly are the common
fragility fractures. This is clearly not the case and we are grateful to a
distinguished group of orthopaedic authors from 11 different countries who
have detailed the spectrum of musculoskeletal trauma in older adults
together with appropriate treatment algorithms.
We have targeted the book at both geriatricians and orthopaedic
surgeons. It will become increasingly important to utilize an orthogeriatric
team approach when treating elderly patients in order to optimize the
functional outcomes for the patients and their families. We therefore cover
both medical and surgical issues, and are fortunate to have a group of
experienced international physicians and surgeons on board. We are grateful
for their industry and expertise. It is our hope that this book will facilitate
communication between surgeons and geriatricians and will also be a
stimulus for increased clinical research in this rapidly expanding area.
Charles M. Court-Brown
Margaret M. McQueen
Marc F. Swiontkowski
David C. Ring
Susan M. Friedman
Andrew D. Duckworth
Contributors
Paul A. Anderson MD
Department of Orthopedics and Rehabilitation, University of Wisconsin,
Madison, Wisconsin
George S. Athwal MD FRCSC
Hand and Upper Limb Center, University of Western Ontario, London,
Ontario, Canada
Roger M. Atkins MA MB BS DM FRCS
Consultant Orthopaedic Surgeon, Bristol Royal Infirmary, Bristol, UK
Jarrad A. Barber MD
Department of Trauma and Orthopaedics, The Hughston Clinic at Gwinnett
Medical Center, Atlanta, Georgia
Jan Bartoníček MD DSc
Department of Orthopaedic, 1st Faculty of Medicine of Charles University
Prague and Central Military Hospital Prague, Czech Republic
Department of Anatomy, 1st Faculty of Medicine of Charles University
Prague, Czech Republic
Leela C. Biant FRCSEd MSres MFSTEd
Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh,
Edinburgh, Scotland
Derek Boersma MSc PT
Department of Geriatric Medicine, Nepean Hospital, Kingswood, NSW,
Australia
Musculoskeletal Ageing Research Program, Sydney Medical School
Nepean, The University of Sydney, Penrith, NSW, Australia
Stig Brorson MD PhD DMSc
Department of Orthopaedic Surgery, Herlev University Hospital, Herlev,
Denmark
Kate E. Bugler BMBCh BA MRCS
Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh,
Edinburgh, Scotland
Susan V. Bukata MD
Department of Orthopaedics, UCLA Health System, David Geffen School
of Medicine, Los Angeles, California
Lisa K. Cannada MD
Department of Orthopaedic Surgery, Saint Louis University, St. Louis,
Missouri
Kevin C. Chung MD MS
Section of Plastic Surgery, Department of Surgery, University of Michigan
Health System, Ann Arbor, Michigan
Nicholas D. Clement PhD MRCS Ed MBBS
Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh,
Edinburgh, Scotland
Charles M. Court-Brown MD FRCS Ed
Department of Trauma and Orthopaedics, University of Edinburgh,
Edinburgh, Scotland
Eleanor Davidson MBChB Hons BSc Hons MRCS Ed
Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh,
Edinburgh, Scotland
Oddom Demontiero MBSS PhD FRACP
Department of Geriatric Medicine, Nepean Hospital, Kingswood, NSW,
Australia
Musculoskeletal Ageing Research Program, Sydney Medical School
Nepean, The University of Sydney, Penrith, NSW, Australia
Tina K. Dreger MD
Department of Orthopaedic Surgery, Saint Louis University, St. Louis,
Missouri
Andrew D. Duckworth BSc(Hons) MBChB MSc FRCSEd(Tr&Orth) PhD
