Orthopedic Injuries

HIP FRACTURES Many elderly patients are predisposed to orthopedic injuries due to osteopenic and osteoporotic changes in their skeletal structure. Hip fracture is the single most common diagnosis that leads to hospitalization in all age groups in the United States. Hip fractures occur primarily in four areas: intertrochanteric, transcervical, subcapital, and subtrochanteric. Intertrochanteric fractures are the most common, followed by transcervical fractures. 9 Emergency physicians must be aware that pelvic and long bone fractures are not infrequently the sole etiology for hypovolemia in elderly patients. Timely orthopedic consultation, evaluation, and treatment with open reduction and internal fixation should be coordinated with the diagnosis and management of other injuries.

LONG BONE FRACTURES Long bone fractures of the femur, tibia, and humerus may produce a loss of mobility with a resulting decrease in the independent lifestyle of elderly patients.9 Geriatric patients who present with femoral fractures have been found to have a significantly higher rate of preexisting medical conditions than patients with proximal humeral fractures.14 Early orthopedic consultation for intramedullary rodding of these fractures may result in increased early mobilization.

UPPER EXTREMITY INJURIES Falls on the outstretched hand increase the elderly's risk for Colles's fractures. After the diagnosis is confirmed by radiographs, these fractures usually can be treated with closed reduction and immobilization. The incidence of humeral head and surgical neck fractures in elderly patients also is increased by falls on the outstretched hand or elbow.9 Localized tenderness, swelling, and ecchymosis to the proximal humerus are characteristic of these injuries. Early orthopedic consultation and treatment with a shoulder immobilizer or surgical fixation should be arranged. Social services may need to be contacted to arrange for assistance with routine daily activities for some elderly patients being discharged home after an orthopedic injury.

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