Hannah Schmidt

Background: Perioperative blood loss represents a major challenge in elderly patients undergoing hip fracture surgery. Although tranexamic acid (TXA) has been shown to reduce bleeding complications, evidence from large registry-based cohorts remains limited. This study assessed the efficacy and safety of perioperative TXA administration in geriatric proximal femoral fracture surgery and evaluated in a subgroup analysis whether repeated TXA administration provides additional benefit compared with a single intraoperative dose. Methods: Data were derived from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU), a prospective multicenter registry of patients aged ≥70 years undergoing surgery for proximal femoral fractures. From a total cohort of 23,830 patients, 1:1 nearest-neighbor matching based on age, sex, America Society of Anesthesiologists (ASA) classification, fracture type, and pre-fracture mobility yielded 3697 patients receiving intraoperative TXA and 3697 controls without TXA. Outcomes included transfusion requirements, thromboembolic events, mortality, reoperation rate, and length of stay. A subgroup analysis compared single-dose intraoperative TXA with combined pre- and intraoperative administration. Results: Intraoperative TXA significantly reduced packed red blood cell transfusion rates compared with controls (44.6% vs. 52.2%; p < 0.001). No significant differences were observed in thromboembolic events, mortality, overall complication rates, or length of hospital stay. Subgroup analysis showed no additional benefit of repeated pre- and intraoperative TXA administration compared with a single intraoperative dose but was associated with a significantly higher incidence of thromboembolic risks in the multiple-dose cohort (3.56% vs. 1.1%; p = 0.038). Conclusions: Intraoperative TXA administration significantly reduces transfusion requirements in geriatric patients undergoing surgery for proximal femoral fractures without increasing thromboembolic complications or mortality. TXA should therefore be considered a safe and effective adjunct in the perioperative management of geriatric hip fracture patients.

Background: Each year, hundreds of thousands of geriatric patients suffer proximal femur fractures, which often result in irreversible functional decline. Although anti-osteoporotic medications have been shown to reduce the incidence of fragility fractures, the effects of pharmacotherapy on fracture injury patterns, postoperative ambulatory capacity, and survival outcomes are not yet fully understood. Methods: We conducted a retrospective cohort study using the AltersTraumaRegister DGU ^® (ATR-DGU), a multicenter prospective registry spanning 196 certified geriatric trauma centers in Germany, Austria, and Switzerland (2016 through 2024). We included patients aged 70 years or older with isolated, surgically treated proximal femur fractures and stratified them by documented use of osteoporosis medication before the index fracture (OM group) versus no pre-fracture therapy (no-OM group). Primary endpoints were mortality during the acute hospital stay and at 120-day follow-up, as well as walking ability—defined as any functional ambulation versus none—at 7 and 120 days postoperatively. The main secondary endpoint was fracture morphology. We fitted multivariable logistic and linear regression models adjusted for age, sex, ASA classification, and anticoagulation; walking-ability models were additionally adjusted for pre-fracture ambulatory status. Results: Of 70,386 patients (mean age, 84.4 years; 70.4% female), 15,771 (22.4%) were receiving osteoporosis medication prior to the index fracture. Patients in the OM group were frailer with worse ASA Scores (80.3% vs. 72.5% with an ASA ≥3) and lower ambulation (62.5% vs. 50.4% requiring at least two crutches or not able to ambulate out of the home environment). Patients in the OM group had a 19% higher chance of sustaining a trochanteric versus a femoral neck fracture than patients in the no-OM group (51.9% vs. 46.8%; adjusted odds ratio 1.19; 95% CI, 1.15 to 1.24; p < 0.001). Pre-existing therapy showed no association with mortality during the acute hospital stay (adjusted OR, 0.93; 95% CI, 0.86 to 1.01; p = 0.098) or with walking ability at 7 days (adjusted OR, 1.03; 95% CI, 0.98 to 1.09; p = 0.198). At the 120-day follow-up (n = 19,544 in the adjusted model follow-up cohort), slightly higher odds of death were observed in the frailer OM group (adjusted OR, 1.12; 95% CI, 1.01 to 1.25; p = 0.04), though the lower confidence bound approached unity. A trend toward improved ambulation was seen in the OM group at 120-day follow-up (adjusted OR, 1.11; 95% CI, 0.99 to 1.25; p = 0.074). Conclusions: Pre-existing osteoporosis therapy was associated with lower odds of femoral neck versus trochanteric fracture patterns. A trend toward improved ambulation accompanied a slightly increased risk of mortality in patients with pre-existing osteoporosis therapy at 120-day follow-up, although this must be weighed against substantial loss to follow-up and residual confounding. More research is needed to understand the effects of anti-osteoporosis medications on patients who do suffer hip fractures despite osteoporotic therapy.

Background: Geriatric trauma centers (ATZ) in Germany provide interdisciplinary care for elderly trauma patients with the objective of enhancing treatment outcomes following proximal femur fractures. Delirium, a prevalent and grave complication in this patient population, has been associated with elevated mortality and functional limitations. The objective of this study was to examine the prevalence and consequences of delirium in proximal femur fractures by utilizing the Registry for Geriatric Trauma (ATR-DGU). Methods: The study encompassed 32,934 patients aged ≥70 years who sustained proximal femoral fractures during the period 2022–2023. The demographic and clinical parameters, fracture type, time of surgery, mobility, complications, and mortality were meticulously documented. The primary endpoint of the study was the occurrence of delirium and its influence of the outcome of hip fracture patients. Additionally an analysis was conducted to account for peri-implant/periprosthetic fractures. Results: Of the 21,127 patients who underwent screening, 23.6% had already been diagnosed with delirium upon admission. The delirium rate did not differ between hip-/pertrochanteric and peri-implant/periprosthetic fractures. Patients in a delirious state were found to be older, frailer, and more dependent on care. They exhibited more non-surgical complications, poorer mobility, and more frequent transfers to nursing homes. In the context of peri-implant/periprosthetic fractures, delirium showed no significant difference regarding surgical revision (p = 0.192) and mortality rates (p = 0.229). Conclusions: Delirium is therefore a prevalent and clinically significant complication. Its early detection and prevention are essential for proximal femur fracture patients in orthogeriatric care.

Background and objectives: Owing to a lack of evidence, the appropriate surgical treatment strategy for geriatric patients with Vancouver type B2 or B3 periprosthetic femoral fractures (PFFs) remains unclear. Data from a large international geriatric trauma registry were analyzed to investigate the medical care situation of such patients, as well as to examine the outcomes related to revision arthroplasty (RA) or open reduction and internal fixation (ORIF). Materials and methods: Datasets from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (ATR-DGU) were analyzed. The ATR-DGU is a prospective, multicenter registry that provides information on geriatric trauma patients. All patients who underwent surgery for PFF were included in this analysis. The outcome parameters included the mortality rate during hospitalization and at the 120-day follow-up, as well as mobility, the EQ-5D-5 L score and the reoperation rate, and were analyzed in relation to RA versus ORIF in Vancouver type B2 or B3 PFF patients. Results: A total of 607 patients with Vancouver type B2 or B3 PFF met the inclusion criteria. Among these patients, 420 underwent RA, and ORIF was performed in 187 patients. Regression analysis of the parameters collected during the acute phase revealed that after 2:1 matching, compared with the RA group, the ORIF group had significantly lower odds for full weight bearing allowed one day after surgery (OR: 0.49; p < 0.001); walking ability after seven days (OR: 0.56; p = 0.005); and the occurrence of nonsurgical complications (OR: 0.59; p = 0.012). The probability of death during follow-up and the EQ-5D-5 L score after seven and 120 days remained unaffected. Conclusions: The results of the present study support the estimate that ORIF represents a valid treatment alternative for Vancouver type B2 and B3 PFFs, as comparable midterm outcomes were demonstrated for each patient group. However, individualized decisions should always be made, especially for multimorbid geriatric patients, to reduce complications.

Background/Objectives: Outcomes for hip fracture patients have improved over the years, yet the population of older patients (≥80 years) continues to grow. By 2100, the global centenarian population is projected to exceed 25 million, but data on hip fracture outcomes in this group are rare and often derived from small samples. This study aimed to analyze outcomes for centenarian hip fracture patients in specialized geriatric trauma centers and compare them with those of patients under 80. Methods: We conducted a retrospective analysis of the AltersTraumaRegister DGU^® from 2016 to 2022, including all proximal femur fracture data. Patients were categorized into two groups: under 80 years and centenarians. The primary outcome was in-hospital mortality, with secondary outcomes including quality of life, walking ability on postoperative day seven, length of hospital stay, readmission rates, and changes in living situations. Results: Among 14,521 patients, 316 were over 99 years old. In-house mortality was significantly higher in centenarians (15.44% vs. 3.58%; p < 0.001), with more discharged to nursing homes. After matching by the Geriatrics at Risk (GeRi) score, mortality differences diminished. Conclusions: While age is a risk factor for mortality, centenarian hip fracture patients’ outcomes do not significantly differ from those aged ≤80 when considering other risk factors.

Background: Orthogeriatric treatment, which involves a collaborative approach between orthopedic surgeons and geriatricians, is generally considered to be superior to standard care following hip fractures. The aim of this study was to investigate additional effects of a geriatrician-led multidisciplinary rehabilitation program. Methods: In this matched paired observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery were included. Between 1 January 2016 and 31 December 2022 data were recorded from hospital admission to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a registry of older adults with hip fractures. Out of 60,254 patients, 9580 patients met the inclusion criteria, 4669 patients received early multiprofessional rehabilitation (EMR) and 4911 patients were treated by standard orthogeriatric co-management (OGC). Results: Compared to standard orthogeriatric treatment, multiprofessional therapy significantly lowered the 7-day mortality rate (2.89% vs. 5.11%) and had a significant impact on walking ability seven days after surgery (86.44% vs. 77.78%). Conclusions: In summary, a geriatrician-led multiprofessional rehabilitation program resulted in lower mortality and improved walking ability than standard orthogeriatric care.