B Buecking1, D Eschbach2, C Bliemel2, M Knobe3, R Aigner2, S Ruchholtz2. 1. Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland. buecking@med.uni-marburg.de. 2. Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH,Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland. 3. Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland.
Abstract
BACKGROUND: Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. OBJECTIVE: The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. MATERIAL AND METHODS: A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). RESULTS: The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. CONCLUSION: The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.
BACKGROUND: Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. OBJECTIVE: The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. MATERIAL AND METHODS: A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). RESULTS: The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. CONCLUSION: The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.
Authors: Michael D McKee; Christian J H Veillette; Jeremy A Hall; Emil H Schemitsch; Lisa M Wild; Robert McCormack; Bertrand Perey; Thomas Goetz; Mauri Zomar; Karyn Moon; Scott Mandel; Shirlet Petit; Pierre Guy; Irene Leung Journal: J Shoulder Elbow Surg Date: 2008-09-26 Impact factor: 3.019