Aims

Debate continues regarding the optimum management of periprosthetic distal femoral fractures (PDFFs). This study aims to determine which operative treatment is associated with the lowest perioperative morbidity and mortality when treating low (Su type II and III) PDFFs comparing lateral locking plate fixation (LLP-ORIF) or distal femoral arthroplasty (DFA).

There is conflicting evidence about the functional outcome and rate of satisfaction of super-elderly patients (≥ 80 years of age) after carpal tunnel decompression. We compiled outcome data for 756 patients who underwent a carpal tunnel decompression over an eight-year study period, 97 of whom were super-elderly, and 659 patients who formed a younger control group (< 80 years old). There was no significant difference between the super-elderly patients and the younger control group in terms of functional outcome according to the mean (0 to 100) QuickDASH score (adjusted mean difference at one year 1.8; 95% confidence interval (CI) -3.4 to 7.0) and satisfaction rate (odds ratio (OR) 0.78; 95% CI 0.34 to 1.58). Super-elderly patients were, however, more likely to have thenar muscle atrophy at presentation (OR 9.2, 95% CI 5.8 to 14.6). When nerve conduction studies were obtained, super-elderly patients were more likely to have a severe conduction deficit (OR 12.4, 95% CI 3.0 to 51.3). Super-elderly patients report functional outcome and satisfaction rates equal to those of their younger counterparts. They are more likely to have thenar muscle atrophy and a severe nerve conduction deficit at presentation, and may therefore warrant earlier decompression. Cite this article: Bone Joint J 2014; 96-B:1234–8

This study describes the epidemiology and outcome of 637 proximal humeral fractures in 629 elderly (≥ 65 years old) patients. Most were either minimally displaced (n = 278, 44%) or two-part fractures (n = 250, 39%) that predominantly occurred in women (n = 525, 82%) after a simple fall (n = 604, 95%), who lived independently in their own home (n = 560, 88%), and one in ten sustained a concomitant fracture (n = 76, 11.9%). The rate of mortality at one year was 10%, with the only independent predictor of survival being whether the patient lived in their own home (p = 0.025). Many factors associated with the patient’s social independence significantly influenced the age and gender adjusted Constant score one year after the fracture. More than a quarter of the patients had a poor functional outcome, with those patients not living in their own home (p = 0.04), participating in recreational activities (p = 0.01), able to perform their own shopping (p < 0.001), or able to dress themselves (p = 0.02) being at a significantly increased risk of a poor outcome, which was independent of the severity of the fracture (p = 0.001).

A poor functional outcome after a proximal humeral fracture is not independently influenced by age in the elderly, and factors associated with social independence are more predictive of outcome.

Cite this article: Bone Joint J 2014;96-B:970–7.

Fractures in patients aged ≥ 65 years constitute an increasing burden on health and social care and are associated with a high morbidity and mortality. There is little accurate information about the epidemiology of fractures in the elderly. We have analysed prospectively collected data on 4786 in- and out-patients who presented with a fracture over two one-year periods. Analysis shows that there are six patterns of the incidence of fractures in patients aged ≥ 65 years. In males six types of fracture increase in incidence after the age of 65 years and 11 types increase in females aged over 65 years. Five types of fracture decrease in incidence after the age of 65 years. Multiple fractures increase in incidence in both males and females aged ≥ 65 years, as do fractures related to falls.

Analysis of the incidence of fractures, together with life expectancy, shows that the probability of males and females aged ≥ 65 years having a fracture during the rest of their life is 18.5% and 52.0%, respectively. The equivalent figures for males and females aged ≥ 80 years are 13.3% and 34.8%, respectively.

Cite this article: Bone Joint J 2014;96-B:366–72.

We describe the outcome of tibial diaphyseal fractures in the elderly (≥ 65 years of age). We prospectively followed 233 fractures in 225 elderly patients over a minimum ten-year period. Demographic and descriptive data were acquired from a prospective trauma database. Mortality status was obtained from the General Register Office database for Scotland. Diaphyseal fractures of the tibia in the elderly occurred predominantly in women (73%) and after a fall (61%). During the study period the incidence of these fractures decreased, nearly halving in number. The 120-day and one-year unadjusted mortality rates were 17% and 27%, respectively, and were significantly greater in patients with an open fracture (p < 0.001). The overall standardised mortality ratio (SMR) was significantly increased (SMR 4.4, p < 0.001) relative to the population at risk, and was greatest for elderly women (SMR 8.1, p < 0.001). These frailer patients had more severe injuries, with an increased rate of open fractures (30%), and suffered a greater rate of nonunion (10%).

Tibial diaphyseal fractures in the elderly are most common in women after a fall, are more likely to be open than in the rest of the population, and are associated with a high incidence of nonunion and mortality.

Cite this article: Bone Joint J 2013;95-B:1255–62.

There is limited literature regarding the outcome of hip and knee arthroplasty (THR and TKR) in the Super-Elderly (≥80yrs). The aim is to compare the outcome of THR and TKR in the Super-Elderly with a standard-age cohort of patients. From January 2006 to August 2008; 1290 TKR and 1344 THR were performed at the study institute. Comorbidity, length of stay, patient satisfaction, Oxford knee or hip scores, and SF12 scores were recorded prospectively. The Oxford Score and SF12 were recorded at one year. The mode age range was 65-74yrs for TKR (n=492) and THR (n=495), deemed the standard cohort. 185 TKR and 171 THR were performed in the Super-Elderly. Outcome in this cohort was compared to the standard. The standard cohort had a greater absolute improvement in Oxford knee scores (15.8 and 14.7.p=0.2). Improvement of absolute Oxford hip scores revealed no difference (20.0 and 20.2.p=0.8), but the Super-Elderly had a greater improvement in pain components (11.0 vs.12.0.p=0.05) with a lesser improvement of the functional components (9.0.vs.8.2.p=0.05). There was a greater improvement in the physical component of the SF-12 score in the standard cohort for both TKR and THR (10.6.vs.7.9.p=0.05 and 14.4.vs.10.4.p=<0.01, respectively). No significant difference was seen in comorbidities, but the Super-Elderly patients had a longer hospital stay for TKR (6.2.vs.8.3.p=0.01) and THR (5.9.vs.9.0.p=0.01). The Super-Elderly were more satisfied with their surgery (p=0.05). Super-Elderly patients have comparable outcomes to their younger counterparts and are more satisfied with their surgery, but they may require a longer length of stay

The epidemiology of adult fractures is changing rapidly. The longevity of the population continues to extend with increasing incidence of fragility fractures. The aim of this study was to map the epidemiology of fractures in patients 90 years and older. A retrospective review of all orthopaedic trauma patients over the age of 89 years attending Edinburgh Royal Infirmary in 2000 was performed. All inpatients and outpatients were included. These patients were identified using a prospectively complied database held by the senior author. Patient notes were used to confirm place of residence, mobility, co-morbidity, management, length of admission and place of discharge. 236 fractures (4% of all fractures) were identified. There were 209 (89%) female patients. All were secondary to low energy trauma. More than 50% of the patients were admitted from home and mobilised independently or with a stick. 124 (53%) patients had nil or one co-morbidity, the commonest being dementia and hypertension. Of the 133 neck of femur (NOF) fractures 11 (8%) died as inpatients, and of the 66 patients residing independently in their own home only 5 (8%) returned with the other 61 needing step-up care. The average length of stay in hospital for NOF fractures was 13 days. The majority of patients are female and reside at home, being independently mobile and have limited co-morbidity. The length of stay is relatively long and few patients’ return directly home following a NOF fracture. This, with the ever-growing super-elderly population, will have substantial financial implications in the future