The number of patients with osteoporosis is steadily rising, along with the frequency of related fractures. The economic burden as well as the use of health care resources will increase to unprecedented levels over the next decade. Since patients with osteoporotic fractures are frequently elderly, comorbidities are highly prevalent, leading to an increased risk of perioperative complications. Therefore, a multidisciplinary approach is required in which the orthopaedic surgeon plays a pivotal role, often as the coordinating physician. Apart from advanced skills in fracture management, a thorough understanding of frequent complications and measures that lead to their early detection and prevention are therefore required. This article reviews the most relevant perioperative aspects that affect the preoperative, intraoperative and postoperative periods of fragility fracture management in the elderly population. Preoperative cardiovascular testing is discussed, as well as its effect on surgical timing. Measures to improve outcomes related to frequently found malnutrition and anemia are presented, as are prevention of surgical site infection, deep venous thrombosis, gastrointestinal hemorrhage, urinary retention and delirium. Finally, aspects of fracture management and fixation, as well as the initiation of early measures for subsequent fracture prevention are examined.

Orthopedic Trauma Service Department of Orthopedic Surgery Washington University School of Medicine St Louis Missouri

Fragility fractures: preoperative, perioperative and postoperative management

Ortopedická traumata

Lit.: 95