Orthopedic trauma in the elderly patient presents both a medical and a surgical challenge. This growing population requires injury management tailored to specific patient needs. Injury treatment is based on patient factors, injury factors, and other special considerations to optimize outcome. The goal of injury treatment in the elderly patient is enabling return to preinjury functional status. This chapter will focus on the treatment of some of the more common injuries encountered in the elderly, including proximal humerus fractures, rotator cuff tears, wrist fractures, hip fractures, ankle fractures, and vertebral compression fractures.

PATIENT FACTORS

Preinjury Status

The goal of injury treatment in the elderly patient is a return to preinjury status. Therefore, a thorough history-taking that includes preinjury function is pivotal to guiding effective orthopedic care. The treatment goals of an independent community-dwelling ambulatory patient who sustains a hip fracture are different from those of an institutionalized nonambulatory patient. The former requires early operative intervention combined with aggressive postoperative rehabilitation, whereas the latter requires a less aggressive approach that provides for comfortable transfers and the ability to sit. Although the goal of each is to return to preinjury status, the approaches to each differ significantly.

Systemic Disease

Elderly patients often have preexisting medical comorbidities that influence musculoskeletal injury treatment. Cardiopulmonary disease is common in this population and affects the patient's ability to tolerate anesthetics, undergo surgery, and participate in a postoperative rehabilitation program.