Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Oct 2013
ReviewStress ulcer prophylaxis, thromboprophylaxis and coagulation management in patients with hip fractures.
Hip fracture in older patients is a major health concern. 20-25 % of hip fracture patients will die in the first year after the trauma (Lane, Clin Orthop Relat Res 471(8):2711, 2013). Postoperative venous thrombosis and gastrointestinal stress-ulcer bleeding are frequent complications with a high case-fatality rate particularly in older patients. ⋯ A thorough literature search was done, using the terms "orthogeriatrics" and "hip fracture" in combination with "stress ulcer", "gastrointestinal bleeding" and "thrombosis", "thromboprophylaxis". The data was collected, discussed and evaluated in several adjustment meetings of the group and summarized in this article.
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Wien Med Wochenschr · Oct 2013
ReviewTreatment and prevention of postoperative complications in hip fracture patients: infections and delirium.
The course of older patients with hip fractures is often complicated by infections and delirium. Accurate care and high suspicion for these complications are essential, since these conditions are associated with an increase in mortality, length of hospital stay and nursing home placement, poorer mobility, and functional decline. Because of immunosenescence and higher infection rates, older patients need specific care, immediate diagnosis, and treatment of infections. ⋯ Advanced age, cognitive impairment, hearing loss, peripheral vascular disease, prior delirium episodes, sight disorders, and polypharmacy are established risk factors for delirium; thus, older people with several chronic diseases are prone to delirium. A multifactorial approach, comprising standardized screening, oxygen support, intravenous fluid administration and augmented nutrition, monitoring of vital signs, pain treatment, optimized medication, and modification in perioperative management, significantly reduces delirium incidence during hospitalization for hip fracture. An interdisciplinary approach between surgeons and geriatricians may warrant optimized satisfaction of patients' needs.
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Wien Med Wochenschr · Oct 2013
Review[Procedural organisation: surgical and anaesthesiological management in hip fractures].
In patients with hip fractures, in order to reduce the high number of general complications and those associated with the specific treatment, the functional loss and cognitive impairment, implementation of co-ordinated, multidisciplinary treatment pathways, and rehabilitation, is mandatory. The imminent treatment of proximal femoral fracture consists of major orthopaedic surgery in most cases (total or partial hip arthroplasty, osteosynthesis). After the diagnosis of a hip fracture, an adequate pain medication should be initiated. ⋯ Medical abnormalities should be optimized within 24 to 48 h, or an increased perioperative risk due to comorbidities has to be accepted. The timing and the course of further preoperative diagnostic examinations and therapeutic interventions should be co-ordinated between the involved medical disciplines. After the operation a structured screening for delirium should be initiated and further evaluation of patient's nutrition, fall-associated medication, living conditions and osteoporosis treatment has to be performed.