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Fractures in the Elderly A Guide to Practical Management

:	Robert J. Pignolo, Mary Ann Keenan, Nader M. Hebela
:	Robert J. Pignolo, Mary Ann Keenan, Nader M Hebela
:	Fractures in the Elderly A Guide to Practical Management
:	Humana Press
:	9781603274678
:	1
:	CHF 212.20
:

:	Klinische Fächer
:	English

:	335
:	DRM
:	PC/MAC/eReader/Tablet
:	PDF

Fractures in the Elderly: A Guide to Practical Management provides geriatricians and other medical specialists who provide care for older adults with the vital guidance and most current data and opinions regarding the treatment of elderly patients who sustain a variety of fractures. It also provides orthopedic surgeons with the necessary information and most current data and opinions regarding assessment and management of geriatric conditions that predispose the elderly to fracture, perioperative complications and subsequent functional decline. Each chapter is both readable and appealing not only to geriatricians and orthopedic surgeons but to all clinicians that have contact with elderly patients who have sustained or are at high risk of sustaining a fracture. Emphasis is placed on the fact that although in some cases pre- and post-operative care in elderly fracture patient may proceed as it does in younger individuals, often there are considerations owing to functional status, pre-existing conditions, and age-related physiological declines that require specialized knowledge and alternative approaches. Developed by a group of renowned experts, Fractures in the Elderly: A Guide to Practical Management is a major addition to the literature and provides a wealth of specialized knowledge and approaches to care. It is an essential reference for all clinicians who care for older adults as well as fellows and residents in training.

	Preface	6
	Contents	8
	Contributors	10
	Part I: The Aging of Bone and Etiologies of Fractures	14
	Chapter 1: Osteobiology of Aging	15
	1.1 Introduction	15
	1.2 Basic Anatomy of Bone	16
	1.2.1 Bony Matrix	16
	1.2.2 Cortical Bone	16
	1.2.3 Trabecular Bone	17
	1.3 Basic Multicellular Units	17
	1.3.1 Osteoclasts	18
	1.3.2 Osteoblasts	18
	1.3.2.1 Osteoblast Versus Adipocyte Differentiation	21
	1.3.3 Osteocytes	22
	1.4 Bone as a Mineral Reservoir	22
	1.5 Skeletal Maintenance and Remodeling	23
	1.5.1 Activation (Phase 1)	23
	1.5.1.1 Osteoprotegerin/RANK/RANKL	23
	1.5.2 Resorption (Phase 2)	24
	1.5.3 Reversal (Phase 3)	24
	1.5.4 Formation (Phase 4)	25
	1.6 Regulation of Bone Remodeling	26
	1.6.1 Vitamin D and Osteomalacia	26
	1.6.1.1 Vitamin D and Aging	26
	1.6.1.2 Vitamin D-Related Myopathy	27
	1.6.1.3 Vitamin D and Risk of Falls and Fracture	27
	1.6.2 Parathyroid Hormone and Secondary Hyperparathyroidism	27
	1.6.3 Gonadal Hormones	28
	1.6.4 Thyroid Hormone	29
	1.6.5 Growth Hormone/Insulin-Like Growth Factors	29
	1.6.6 Interleukins	30
	1.6.7 Calcitonin	30
	1.6.8 Fibroblast Growth Factors and Transforming Growth Factor-b	30
	1.7 The Pathophysiology of Bone Loss in the Elderly	31
	1.7.1 Age-Related Bone Loss	31
	1.7.2 Postmenopausal Osteoporosis	32
	1.7.3 Somatopause	33
	1.7.4 Androgen Decline in the Aging Male Syndrome and Andropause	34
	1.7.5 Renal Osteodystrophy	35
	1.7.6 Skeletal Unloading/Immobilization	36
	1.7.7 Tobacco- and Alcohol-Related Bone Loss	37
	1.7.8 Drug-Induced Osteoporosis	38
	1.7.8.1 Glucocorticoid-Induced Osteoporosis	39
	1.8 Cellular Senescence	40
	1.8.1 Telomere Shortening and Telomerase Dysfunction in Aging Bone	42
	References	42
	Chapter 2: Pathologic Fractures	55
	2.1 Introduction	55
	2.2 Metastatic Tumors of Bone	56
	2.2.1 Location	56
	2.2.2 Presentation	56
	2.2.3 Diagnostic Laboratory Tests	57
	2.2.4 Imaging	57
	2.2.5 Management Options	59
	2.2.5.1 Medical/Radiation Therapy	59
	2.2.5.2 Surgery	60
	Indications	60
	Treatment Options	61
	Postoperative Care	61
	2.3 Multiple Myeloma	63
	2.3.1 Presentation	63
	2.3.2 Diagnostic Laboratory Tests	63
	2.3.3 Imaging	63
	2.3.4 Management Options	64
	2.3.4.1 Medical Therapy	64
	2.3.4.2 Surgery	64
	Surgical Treatment Options	64
	Postoperative	65
	References	65
	Chapter 3: Falls	66
	3.1 Introduction	66
	3.2 Epidemiology	67
	3.3 Risk Factors and Screening	67
	3.4 Fall Assessment	68
	3.4.1 Post-fall Assessment and Evaluation	68
	3.4.1.1 First Fall	68
	3.4.1.2 Recurrent Falls	69
	3.5 Fall Prevention	70
	3.5.1 Primary Prevention	70
	3.5.1.1 Exercise	70
	3.5.1.2 Importance of Vitamin D	71
	3.5.1.3 Sarcopenia and Nutrition	72
	3.5.2 Secondary Prevention	73
	3.5.2.1 Technological Devices	74
	3.5.2.2 Hip Protectors	74
	3.5.2.3 Post-fall Interventions	74
	3.5.2.4 Community-based Older Adults	75
	3.5.2.5 Facility-based Older Adults	76
	3.5.2.6 Inpatient-Based Older Adult	76
	3.5.3 Tertiary Prevention	77
	References	77
	Part II: Perioperative Management	80
	Chapter 4: Preoperative Assessment of Risk	81
	4.1 Introduction	82
	4.2 Risk Factors	83
	4.3 Risk Stratification	84
	4.4 Preoperative Cardiac Evaluation	84
	4.5 Preoperative Pulmonary Evaluation	86
	4.6 Infection and Perioperative Antibiotics	87
	4.7 Thromoembolic Risk	87
	4.8 Gastrointestinal Risks and Obesity	88
	4.9 Nutritional Risks	88
	4.10 Renal and Urological Complications	90
	4.11 Perioperative Management of Diabetes Mellitus	91
	4.12 Neurological Risk	91
	4.13 Assessment of Functional Status	92
	4.14 Unnecessary Preoperative Testing	93
	References	94
	Chapter 5: Anticoagulation	97
	5.1 Introduction	97
	5.2 Pharmacologic Methods of Prophylaxis	98
	5.2.1 Aspirin	98
	5.2.2 Vitamin K Antagonists (Warfarin)	100
	5.2.3 Heparins	101
	5.2.4 Fondaparinux	103
	5.3 Timing and Duration of Prophylaxis	104
	5.4 Risks of Anticoagulation	104
	5.4.1 Heparin-Induced Thrombocytopenia	105
	5.5 Nonpharmacologic Methods of Prophylaxis	105
	5.5.1 Inferior Vena Caval Filters	107
	References	108
	Chapter 6: Prevention and Management of Perioperative Delirium	111
	6.1 Background	111
	6.1.1 Significance of Delirium in Elderly Patients with Fractures	111
	6.1.2 Recognizing Delirium	113