Luis Felipe Martínez Miranda

Trauma in elderly patients has become a growing global healthcare challenge due to population aging, increased frailty, and the rising prevalence of chronic diseases and functional dependency. This review aimed to analyze current scientific evidence regarding frailty, functional outcomes, orthopedic complications, and multidisciplinary management strategies in geriatric trauma populations. A narrative and integrative review was conducted using scientific literature obtained from indexed databases including PubMed, Scopus, and peer-reviewed journals. The selected evidence included systematic reviews, meta-analyses, cohort studies, and international guidelines related to traumatology, orthopedics, geriatrics, rehabilitation, and internal medicine. The reviewed literature demonstrated that frailty is one of the most important predictors of adverse outcomes after trauma, including mortality, delirium, prolonged hospitalization, postoperative complications, institutionalization, and incomplete functional recovery. Falls from standing height were identified as the principal mechanism of injury, with hip fractures representing one of the most clinically significant conditions associated with disability and loss of independence. The findings also showed that multidisciplinary orthogeriatric care models improve postoperative recovery, reduce complications, enhance early mobilization, and contribute to better functional outcomes when compared with conventional orthopedic management. Furthermore, the review highlighted important healthcare challenges in Mexico, Colombia, and Ecuador, particularly regarding rehabilitation accessibility, geriatric specialization, and fall prevention strategies. The evidence supports the implementation of patient-centered and frailty-oriented approaches integrating traumatology, orthopedics, geriatrics, rehabilitation medicine, nutrition, nursing, and social support. Ultimately, comprehensive multidisciplinary management appears essential for improving survival, preserving independence, and optimizing quality of life in elderly trauma patients.

Olytrauma is a major cause of mortality, disability, and prolonged critical illness worldwide, particularly among young and economically active populations. Beyond the initial anatomical injury, severe trauma triggers a complex systemic response involving inflammatory activation, endothelial dysfunction, metabolic and endocrine alterations, coagulation abnormalities, immune dysregulation, and progressive organ failure. The objective of this review was to analyze current evidence regarding the inflammatory, metabolic, and organ dysfunction pathways associated with polytrauma from a multidisciplinary perspective integrating traumatology, orthopedics, internal medicine, endocrinology, and critical care medicine. A narrative and integrative literature review was conducted using scientific databases including PubMed/MEDLINE, Scopus, ScienceDirect, PMC, and Google Scholar. Peer-reviewed articles, clinical reviews, trauma guidelines, and observational studies related to systemic trauma physiology, trauma-induced coagulopathy, metabolic dysfunction, and multiple organ dysfunction syndrome were analyzed. The reviewed evidence demonstrated that inflammatory mediators such as interleukin-6, tumor necrosis factor-alpha, complement activation products, and oxidative stress pathways play fundamental roles in systemic deterioration after severe trauma. Simultaneously, hypercatabolism, stress hyperglycemia, insulin resistance, and prolonged endocrine activation contribute significantly to physiologic instability and delayed recovery. Trauma-induced coagulopathy emerged as a dynamic process strongly associated with endothelial injury, inflammatory signaling, hemorrhagic shock, and microvascular dysfunction. Pulmonary, cardiovascular, renal, hepatic, and neurological dysfunction represented the most frequent systemic complications identified during trauma progression.