Geriatric Orthopaedic Surgery & Rehabilitation最新文献

{"title":"Percutaneous Treatment of Geriatric Distal Tibia and Fibula Fractures With a Poor Soft Tissue Envelope - A Case Series.","authors":"Pedram Rajabifard, Joshua Booth, Samuel Hookway, Richard Kjar, Nathan Donovan, Anton Lambers","doi":"10.1177/21514593261446750","DOIUrl":"10.1177/21514593261446750","url":null,"abstract":"<p><strong>Purpose: </strong>Geriatric distal tibia and fibula fractures are typically treated with open reduction and internal fixation (ORIF) or prolonged cast immobilisation. These methods predispose to wound complications and delayed weight-bearing. Percutaneous fixation can offer a stable construct allowing for early weight-bearing while minimising wound complications. This case series details the management and outcomes of patients over 65 with distal tibia and fibula fractures and poor soft tissue envelope treated with percutaneous fixation.</p><p><strong>Methods: </strong>A prospective observational study was conducted at two Victorian orthopaedic units, identifying patients over 65 years of age who underwent percutaneous distal tibia or fibula fracture fixation. Patient selection considered soft tissue quality and overall health. Antegrade tibial intramedullary nails and retrograde percutaneous screws were used. Surgery proceeded without delay for swelling or anticoagulation cessation. Clinical notes and radiographs were analysed for premorbid health, mobility status, injury mechanism and classification, fixation methods, post-operative mobility, and treatment complications.</p><p><strong>Results: </strong>The study identified 13 ankles in 11 patients (average age 82) across two sites. Fractures included 4 trimalleolar, 5 bimalleolar, 1 lateral malleolar, and 3 distal tibia and fibula diaphyseal. Three fractures were open. Median time to operation was 3 days. Six patients were allowed immediate weight-bearing as tolerated. Median post-operative stay was 5 days. One deep infection required removal of a suture-button syndesmosis device and two minor wound breakdowns (distant to surgical site) were managed non-operatively with dressings.</p><p><strong>Conclusion: </strong>Percutaneous distal tibia and fibula fracture fixation appears to be a viable alternative to ORIF in geriatric patients with poor soft tissue envelope, potentially offering reduced complications and earlier mobilisation.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261446750"},"PeriodicalIF":1.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Performance of Frailty Indices for Complications and Functional Recovery After Distal Radius Fracture Surgery in Patients Aged ≥65 years.","authors":"Ekrem Özdemir, Fatih Emre Topsakal, Nasuhi Altay, Ayşe Güzin Özdemir","doi":"10.1177/21514593261461137","DOIUrl":"10.1177/21514593261461137","url":null,"abstract":"<p><strong>Background: </strong>Distal radius fractures (DRFs) are the most common upper-extremity fractures in older adults. Frailty may modulate postoperative risk, but the comparative prognostic value of widely used frailty indices in DRF surgery is unclear.</p><p><strong>Objective: </strong>To compare the 5-item modified Frailty Index (mFI-5), Clinical Frailty Scale (CFS), and Charlson Comorbidity Index (CCI) for predicting complications and functional outcomes after DRF surgery in patients ≥65 years, and to assess whether machine learning (ML) enhances risk stratification.</p><p><strong>Methods: </strong>We retrospectively analyzed 562 patients (mean age 75.1±4.9 years; 71.7% female) undergoing open reduction and internal fixation (67.1%), closed reduction percutaneous pinning (21.2%), or external fixation (11.7%), with ≥12 months of follow-up. Preoperative mFI-5, CFS, and CCI were collected. The primary endpoint was any postoperative complication (composite of surgical site infection, wound dehiscence, loss of reduction, tendon injury, nonunion/malunion, hardware failure, reoperation, 30-/90-day readmission, venous thromboembolism, and complex regional pain syndrome). Functional outcomes were DASH, PRWE, grip strength, and return to activities of daily living (ADLs). Logistic and Cox regression were used. Exploratory ML models (random forest, gradient boosting) employed 5-fold cross-validation, an 80/20 train-test split, and isotonic calibration.</p><p><strong>Results: </strong>Over 17.9±4.5 months, 195 of 562 patients (34.8%) developed ≥1 complication. mFI-5 ≥2 was associated with higher complication rates (38.2% vs 31.9%) and worse 6-month disability (DASH 55.4 vs 44.5; PRWE 47.9 vs 36.4; all p<0.001). CFS ≥4 predicted lower 12-month grip strength recovery (67.8% vs 74.1%) and reduced ADL return (65.9% vs 78.6%). Discrimination for complications was modest (AUCs: mFI-5 0.552; CFS 0.534; CCI 0.507). ML substantially improved performance (gradient boosting AUC 0.878; random forest AUC 0.812) with superior calibration.</p><p><strong>Conclusions: </strong>mFI-5, CFS, and CCI are associated with postoperative complications and functional recovery after DRF surgery but have limited individual discriminative power. ML-based multivariable models achieve markedly better risk stratification and may support more accurate preoperative counseling and personalized perioperative management.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261461137"},"PeriodicalIF":1.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Hospital Trauma Level on Odds of Non-home Discharge from Hospital Following Dens Fracture.","authors":"Andrew Ni, Doha Hussien, Abhi Rashiwala, Victoria Vargas, Nasa Xu, Jason McCartney, Ralph Zachary Garza","doi":"10.1177/21514593261460566","DOIUrl":"10.1177/21514593261460566","url":null,"abstract":"<p><strong>Introduction: </strong>Dens fractures are cervical spine injuries with high morbidity and mortality in the elderly. Many patients require discharge to rehabilitation facilities or skilled nursing care, which impacts patient recovery, healthcare system resource allocation, and prognosis. This study evaluated the effect of trauma center level designation on discharge disposition in patients with dens fractures.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study using data from a Texas State Trauma Registry from 2020 to 2022. Patient demographics, injury characteristics, and outcomes were queried in patients with dens fractures. Discharge home was defined as home discharge with or without home health services. Non-home discharge (NHD) was defined as discharge to another facility. Differences in discharge disposition were analyzed using adjusted binary and multinomial logistic regressions with 95% confidence intervals. Baseline characteristics were analyzed with chi-square and Kruskal-Wallis tests with post-hoc Dunn test for pairwise comparisons.</p><p><strong>Results: </strong>A total of 904 patients were included. After excluding patients who died during hospitalization or were discharged to locations not included in the analysis (e.g., against medical advice, jail, or psychiatric facilities), 433 (52.9%) patients were discharged home while 385 (47.1%) patients had a NHD. Patients treated at level II trauma centers were almost twice as likely to have a NHD compared to patients who were treated at a level I (OR=1.98; 95% CI, 1.39-2.83; p<0.001). Lower-level trauma centers combined (levels II to IV) also had higher odds of a NHD compared to patients who were treated at a level I trauma center (OR=2.03, 95% CI, 1.47-2.79; p<0.001). These findings remained significant when patients discharged from the ED without inpatient admission were excluded (OR=1.52; 95% CI, 1.08-2.14; p=0.016).</p><p><strong>Discussion: </strong>Patients with dens fractures treated at Level I trauma centers were significantly more likely to undergo home discharge than those treated at lower-level centers. Trauma center level may play an important role in discharge outcomes for this high-risk population. Further research is needed to identify specific practices contributing to this difference in discharge disposition.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261460566"},"PeriodicalIF":1.8,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility and Safety of Bone Cement Augmentation in Intramedullary Nailing for Proximal Femur Fractures: A Multicenter Prospective Observational Study.","authors":"Masahiro Matsumoto, Hyonmin Choe, Naomi Kobayashi, Kazuyoshi Yamamoto, Kousuke Matsuo, Hiroyuki Makita, Daisuke Enomoto, Yuta Hieda, Yutaka Inaba","doi":"10.1177/21514593261441131","DOIUrl":"10.1177/21514593261441131","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal femur fractures are common in older adults and are associated with high morbidity and mortality. Bone cement augmentation during intramedullary nailing has been reported to improve implant stability; however, its clinical utility and safety in Japan remain unclear.</p><p><strong>Materials and methods: </strong>This multicenter prospective observational study included patients aged ≥45 years who underwent intramedullary nailing for trochanteric or basicervical femoral fractures between May 1, 2021, and July 31, 2023. Cement augmentation was applied exclusively to patients aged ≥60 years. Femoral neck fractures were excluded. Patients were treated with cement augmentation (CA group) or without augmentation (N group). The primary outcome was screw cut-out within 6 months postoperatively. Secondary outcomes included sliding distance (>5 mm), reoperation, nonunion, postoperative infection, and other complications. Group comparisons were performed using two-sided statistical tests with p < 0.05 considered significant.</p><p><strong>Results: </strong>A total of 300 patients were analyzed (CA, n=97; N, n=203; mean age 86.8 years). No cut-out occurred in the CA group, whereas four cases (1.9%) occurred in the N group (p = 0.12). Sliding distance >5 mm was observed in 2 patients (2.0%) in the CA group and 12 patients (5.9%) in the N group (p = 0.108). Postoperative complications occurred in 2 patients (2.1%) in the CA group and 12 patients (5.9%) in the N group (p = 0.12). No cement-related adverse events were observed.</p><p><strong>Conclusions: </strong>Cement augmentation during intramedullary nailing was safe and showed numerically lower rates of cut-out and excessive sliding compared with non-augmented fixation. Although statistical significance was not reached, these findings suggest a potential clinical role in elderly patients at high risk of fixation failure. Randomized controlled trials are warranted.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261441131"},"PeriodicalIF":1.8,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting 90-Day Mortality After Geriatric Hip Fracture Using Combined Preoperative and Perioperative Risk Factors.","authors":"Murat Erem, Cihan Unyilmaz, Sinem Erem, Savas Yildirim, Esref Selcuk, Mert Ozcan, Cem Copuroglu","doi":"10.1177/21514593261456505","DOIUrl":"10.1177/21514593261456505","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in the elderly are associated with high 90-day mortality rates. Most existing predictive models rely solely on preoperative variables. This study aimed to develop two parallel risk score models integrating preoperative and perioperative factors to predict 90-day mortality.</p><p><strong>Methods: </strong>Medical records of patients aged ≥65 years who underwent hip fracture surgery at our institution between January 2018 and December 2024 were retrospectively reviewed. <b>Five preoperative risk factors were evaluated: Prognostic Nutritional Index <40, age ≥85 years, ≥4 comorbidities, surgical delay >5 days, and intracapsular fracture.</b> The >5-day surgical delay threshold was determined empirically through receiver operating characteristic analysis, as the conventional 48-hour cut-off lacked discriminative capacity in this cohort where 86.8% of patients exceeded it. Model performance was assessed using logistic regression and receiver operating characteristic analysis.</p><p><strong>Results: </strong>Of 388 patients enrolled, 387 constituted the analytical sample (60 deaths). The 90-day mortality rate was 15.5%. Individually, each factor showed weak to moderate discrimination. <b>The preoperative five-factor score achieved an AUC of 0.722, and the combined six-factor score - which additionally incorporates ICU stay ≥5 days - achieved an AUC of 0.737.</b> Each unit score increase raised mortality odds approximately 2.68-fold. In patients scoring ≥4, mortality exceeded 50%. The Hosmer-Lemeshow test confirmed adequate calibration for both models.</p><p><strong>Conclusion: </strong>A two-stage scoring approach combining admission-available and postoperative variables demonstrated acceptable discrimination and calibration for 90-day mortality <b>prediction in elderly hip fracture patients, supporting its use as a practical risk stratification tool at both preoperative and postoperative clinical decision points.</b></p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261456505"},"PeriodicalIF":1.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Period-Specific Determinants of Mortality After Geriatric Hip Fracture: Insights into Inflammation, Comorbidity and Surgical Timing.","authors":"Mustafa Bulut, Muhammed Furkan Darilmaz, Çağlar Tuna Issi, Berat Can, Hakan Yolaçan, Serkan Güler","doi":"10.1177/21514593261456502","DOIUrl":"10.1177/21514593261456502","url":null,"abstract":"<p><strong>Background: </strong>Mortality remains high after geriatric hip fractures. Evaluating postoperative mortality across distinct time windows may allow a more accurate clinical interpretation of phase-specific risk determinants.</p><p><strong>Objective: </strong>To assess clinical and laboratory factors associated with mortality at 0-30 days, 30-90 days, and 90-365 days after hemiarthroplasty for geriatric hip fractures.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, 433 consecutive patients aged ≥65 years who underwent hemiarthroplasty between January 2019 and November 2024 were analyzed. Phase-specific determinants of mortality were evaluated using a three-interval landmark approach with multivariable logistic regression models (0-30, 30-90, and 90-365 days). Discrimination was assessed with ROC analysis; Kaplan-Meier analyses were reported as supportive findings.</p><p><strong>Results: </strong>Mortality was 17.1% at 0-30 days, 6.2% at 30-90 days, and 12.9% at 90-365 days. In multivariable analyses, 0-30-day mortality increased with age (OR 1.17) and Charlson Comorbidity Index (CCI) (OR 1.72), while female sex was protective (OR 0.28). Shorter time-to-surgery showed an inverse association with early mortality (OR 0.97 per hour). For 30-90 days, mortality was associated with log(CRP+1) (OR 1.62). For 90-365 days, mortality was associated with age (OR 1.06), higher ASA score (OR 2.60), and lower albumin (OR 0.92 per g/L). In ROC analyses, age yielded an AUC of approximately 0.70; CRP and CCI showed time-dependent AUC values ranging from 0.55 to 0.66, indicating limited discrimination for use as standalone clinical decision-support tools.</p><p><strong>Conclusion: </strong>Determinants of mortality after geriatric hip fracture vary across postoperative phases. Early mortality is more closely associated with comorbidity burden, intermediate mortality with inflammatory markers, and late mortality with indicators related to physiological reserve and nutritional status. Given the retrospective design, these findings should be interpreted as associations rather than causal effects, and triage-related bias/residual confounding cannot be excluded.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261456502"},"PeriodicalIF":1.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deltoid Tuberosity Index as a Predictor of Hip Fracture Risk in Older Adults.","authors":"Nuri Koray Ülgen, Ali Said Nazlıgül, Nihat Yiğit, Sadık Emre Erginoğlu, Nurettin Mantı, Ünal Demir, Arslan Kağan Arslan, Mehmet Orçun Akkurt","doi":"10.1177/21514593261456067","DOIUrl":"10.1177/21514593261456067","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures are among the most common osteoporotic injuries in older adults, and early identification of high-risk individuals is essential for their prevention. Although dual-energy X-ray absorptiometry (DEXA) remains the standard method for measuring bone mineral density (BMD), access to this modality is limited in many regions. The deltoid tuberosity index (DTI), which is measured on proximal humeral images and visible on routine chest radiographs, may be a simple and accessible indicator of systemic osteoporosis.</p><p><strong>Methods: </strong>This retrospective study included 1,012 patients aged ≥60 years who underwent surgery for hip fractures and had preoperative chest radiographs suitable for DTI measurement. The normal DEXA group consisted of 75 individuals with normal BMD (DEXA T-score ≥ -1.0) who had chest or shoulder radiographs taken within 6 months of their DEXA scan. DTI measurements were independently performed by two observers. Interobserver and intraobserver reliabilities were analyzed using intraclass correlation coefficients (ICC). Group comparisons, age-related associations, and receiver operating characteristic (ROC) analyses were conducted to evaluate the predictive performance of DTI.</p><p><strong>Results: </strong>DTI was measurable in 74.7% of chest radiographs. The hip-fracture group showed significantly lower DTI values than the normal DEXA group (mean, 1.294; p<0.001). The measurement reproducibility was excellent, with inter- and intraobserver ICC values of 0.95. ROC analysis demonstrated strong discrimination for predicting hip fracture (AUC=0.903). The optimal cutoff value was 1.377, corresponding to 84.6% sensitivity and 86.7% specificity.</p><p><strong>Conclusions: </strong>DTI is a simple, reliable, and easily obtainable measurement from routine chest radiographs and is strongly associated with hip fractures and systemic osteoporosis. Its high reproducibility and diagnostic performance highlight its potential as an opportunistic screening tool, particularly in settings with limited access to DEXA.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261456067"},"PeriodicalIF":1.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Distal Radius Fractures in Frail Elderly Patients With High Anesthetic Risk: Cast Immobilization Versus Volar Locking Plate Fixation.","authors":"Nihat Yiğit, Ali Said Nazlıgül, Nuri Koray Ülgen, Sadık Emre Erginoğlu, Murat Bozbek, Mehmet Orçun Akkurt","doi":"10.1177/21514593261455274","DOIUrl":"10.1177/21514593261455274","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Distal radius fractures are common among elderly patients and frequently pose management challenges due to advanced age, multiple comorbidities, and increased anesthesia-related risks. In high-risk individuals with limited physiological reserve, the choice between surgical and nonoperative treatment remains controversial. This study aimed to compare the functional, radiological, and complication outcomes of volar locking plate fixation and cast immobilization in elderly patients with distal radius fractures and high anesthetic risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective, single-center comparative study included patients aged ≥65 years with acute distal radius fractures and an American Society of Anesthesiologists (ASA) class ≥III, treated either with cast immobilization or volar locking plate fixation between January 2022 and December 2023. Functional outcomes were assessed using the Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS), grip strength, and Activities of Daily Living (ADL) at 6 and 12 months. Radiological parameters, including radial height, radial inclination, volar tilt, and ulnar variance, were evaluated using standardized digital measurements. Treatment-related complications were recorded and analyzed. Statistical analyses included independent-samples t-tests, chi-square tests, and effect size calculations, with a p-value &lt;0.05 considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 60 patients (30 treated with cast immobilization and 30 treated with volar locking plate fixation) met the inclusion criteria and were included in the final analysis. No statistically significant differences were observed between the two groups in terms of Patient-Rated Wrist Evaluation (PRWE) scores, Visual Analog Scale (VAS) scores, grip strength, or independence in activities of daily living at either 6 or 12 months of follow-up (all p &gt; 0.05). Radiological parameters were largely comparable between groups at final follow-up; however, volar tilt and ulnar variance demonstrated significantly more favorable values in the volar locking plate group. The overall complication rates were similar between treatment modalities. Malunion and complex regional pain syndrome were observed in both groups, with higher-but not statistically significant-rates in the cast immobilization group. No major complications, including deep infection, tendon rupture, neurovascular injury, implant failure, or reoperation, were encountered during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In elderly high-risk patients with distal radius fractures, volar locking plate fixation provides functional and radiological outcomes comparable to those of cast immobilization. Despite the surgical nature of plate fixation, it did not demonstrate a clear functional advantage over conservative management in this frail population. Given its truly nonoperative character and low complication profile, cast immo","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261455274"},"PeriodicalIF":1.8,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Management of Odontoid Fractures in Octogenarians: Beyond Radiological Union.","authors":"Mariam Babunashvili, Benjamin H L Harris, Michael B Fertleman, Louis J Koizia","doi":"10.1177/21514593261456493","DOIUrl":"10.1177/21514593261456493","url":null,"abstract":"","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261456493"},"PeriodicalIF":1.8,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Acute Kidney Injury in Older Adults With Extracapsular Hip Fractures.","authors":"Elizabeth Nocera, Dilan Prasad, Monica DiFiori, Saqib Rehman","doi":"10.1177/21514593261441096","DOIUrl":"10.1177/21514593261441096","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative acute kidney injury (AKI) is a common and serious complication following hip fracture surgery in older adults. This study aimed to identify predictors of postoperative AKI and evaluate its association with short-term complications after extracapsular hip fracture surgery.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using TriNetX Analytics, a federated electronic health record network of 109 United States healthcare organizations (2015-2025). Adults aged ≥ 65 years undergoing extracapsular hip fracture surgery (CPT 27244/27245) were included; those with prior AKI (ICD-10-CM N17) were excluded. Propensity score matching was performed 1:1. Predictors were assessed using Cox proportional hazards modeling and postoperative complications were compared using risk ratios, odds ratios, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>Among 46,287 eligible patients, 1,413 matched pairs (n=2,826) were analyzed. Predictors of postoperative AKI included Black race (HR=1.64), White race (HR=1.21), elevated preoperative serum chloride (HR=1.04), bicarbonate (HR=1.03), creatinine (HR=1.18), and decreased serum protein (HR=1.11). Protective factors included Hispanic/Latino ethnicity (HR=0.70), preoperative opioid use (HR=0.58), elevated serum sodium (HR=0.97), and Tdap vaccination (HR=0.82). Postoperative AKI was associated with increased 30-day risk of myocardial infarction (RR=8.01), sepsis (RR=5.99), respiratory failure (RR=5.30), arrhythmia (RR=2.22), deep vein thrombosis (RR=1.98), transfusion (RR=1.92), and mortality (RR=2.22).</p><p><strong>Conclusions: </strong>Postoperative AKI was independently associated with increased short-term morbidity and mortality following extracapsular hip fracture surgery in older adults. Recognition of perioperative risk factors may support earlier identification and targeted strategies to reduce AKI incidence and improve postoperative outcomes.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"17 ","pages":"21514593261441096"},"PeriodicalIF":1.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}