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Trauma in elderly

Chao Xiong, Zhiquan Zhang, Gurpreet S Baht, Niccolo Terrando
Surgery is commonly used to improve and maintain quality of life. Unfortunately, in vulnerable patients such as the elderly, complications may occur and significantly diminish the outcome. Indeed, after routine orthopedic surgery to repair a fracture, as many as 50% of elderly patients suffer from neurologic complications like delirium. Also, the capacity to heal and regenerate tissue after surgery decreases with age, and can impact the quality of fracture repair and even osseous integration of implants. Thus, a better understanding of mechanisms that drive these age-dependent changes could provide strategic targets to minimize risk for such complications and optimize outcomes...
February 27, 2018: Journal of Visualized Experiments: JoVE
Andres X Samayoa, Thai Vu, Tanya Olszewski, Michael Bova, Qi Yan, Orlando Kirton
INTRODUCTION: Managing trauma in the elderly is challenging and requires a multidisciplinary team approach. The aim of this study is to characterize and compare outcomes in patients 90 years and older in the last two decades. METHODS: Retrospective review of trauma patients 90 years and older admitted from 1996 to 2015. The patients were divided into two groups: Early Decade (ED) and Late Decade (LD). RESULTS: A total of 1697 patients were recorded, 551 (ED) and 1146 (LD)...
March 9, 2018: American Journal of Surgery
M Gioffrè-Florio, L M Murabito, C Visalli, F P Pergolizzi, F Famà
AIM: Trauma, in geriatric patients, increases with age, and is a leading cause of disability and institutionalization, resulting in morbidity and mortality. The aim of our study was to analyse the prevalence of trauma, the related risk factors, mortality and sex differences in the prevalence in a geriatric population. PATIENTS AND METHOD: We observed 4,554 patients (≥65 years) with home injuries or car accidents. Patients were evaluated with ISS (Injury Severity Score) and major trauma with ATLS (Advanced Trauma Life Support)...
January 2018: Il Giornale di Chirurgia
Rahman Barry, Errington Thompson
INTRODUCTION: Rib fractures after blunt trauma contribute substantially to morbidity and mortality in the elderly. METHODS: Retrospective review of 255 patients ≥65 years old at a level 2 trauma center over 6 years, who sustained blunt trauma resulting in rib fractures. Outcomes measured include mortality, hospital length of stay(LOS), intensive care unit(ICU) admission, ICU LOS, need for MV, and MV days. RESULTS: There were 24 deaths (9...
March 9, 2018: American Journal of Surgery
Olga Gutkowska, Jacek Martynkiewicz, Marek Stępniewski, Jerzy Gosk
Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed...
2018: BioMed Research International
Phillip M Mitchell, Cory A Collinge, David E O'Neill, Jesse E Bible, Hassan R Mir
OBJECTIVES: To determine whether sarcopenia is an independent predictor of mortality in geriatric acetabular fractures. DESIGN: Retrospective cohort. SETTING: ACS Level I trauma center. PATIENTS/PARTICIPANTS: One hundred and forty-six patients over the age 60 with acetabular fractures treated at our institution over a 12-year period. MAIN OUTCOME MEASUREMENTS: The primary outcome was 1-year mortality, collected using the Social Security Death Index...
March 5, 2018: Journal of Orthopaedic Trauma
Rony-Orijit Dey Hazra, Helmut Lill, Gunnar Jensen, Julia Imrecke, Alexander Ellwein
Around one third of humeral fractures and 2-6% of all fractures occur to the distal part of the humerus. There is a bimodal distribution differentiating between young male patients with high-energy and elderly female patients with low-energy trauma related to osteoporosis. The AO classification and Dubberley subclassification are used in daily routine. Most fractures are diagnosed on radiographs. For further evaluation, three-dimensional computed tomography is recommended, especially for comminuted or complex fractures...
2018: Obere Extremität
Gesa Bakker, Joerg Hattingen, Hartmut Stuetzer, Joerg Isenberg
OBJECTIVE: The diagnosis of insufficiency fractures of the sacrum in an elder population increases annually. Fractures show very different morphology. We aimed to classify sacral insufficiency fractures according to the position of cortical break and possible need for intervention. METHODS: Between January 1, 2008 and December 31, 2014, all patients with a proven fracture of the sacrum following a low-energy or an even unnoticed trauma were prospectively registered : 117 females and 13 males...
March 2018: Journal of Korean Neurosurgical Society
Hans-Eric Rosberg, Lars B Dahlin
BACKGROUND: Both the number and the proportion of elderly people in the society increase. The number of elderly subjects with a disability due to a disease has decreased resulting in more active elderly. Therefore, an increase in numbers of injury in the elderly population can be expected; a hypothesis that was investigated in the present study. METHODS: Two-hundred sixteen patients with an age of > 65 years, and admitted to a hand surgery ward with a hand injury, were retrospectively collected at four different 2-years periods over a 30 years time (1980-81 to 2010-11)...
March 9, 2018: BMC Geriatrics
Marta Novelo, Armin von Gunten, Gabriel Behr Gomes Jardim, Lucas Spanemberg, Irani Iracema de Lima Argimon, Eduardo L Nogueira
Childhood maltreatment is a risk factor for depression in nonelderly individuals. We investigated the effect of childhood abuse and neglect on the development of geriatric depression and its severity in socioeconomically disadvantaged individuals. A cross-sectional study investigated 449 individuals aged 60-103 years sorted by data using the enrollment list health coverage from the city of Porto Alegre, Brazil. The fifteen-item Geriatric Depression Scale was used to assess depression. The Childhood Trauma Questionnaire was used to identify emotional and physical neglect, in addition to emotional, physical, and sexual abuse...
March 6, 2018: Child Abuse & Neglect
Haruo Hanyu
There is a wide range of potentially modifiable risk factors for Alzheimer's disease and dementia, including cardiovascular risk factors (e.g. hypertension, diabetes, dyslipidemia, obesity, sleep-apnea syndrome), psychosocial factors (e.g., depression), health behaviors (e.g., low level of physical or mental activity, smoking status), and head trauma. In the elderly, weight loss associated with frailty and sarcopenia is another risk factor for dementia. Recent epidemiological studies have shown that the prevalence of dementia has declined in the US and European countries during the last 20 years...
March 2018: Brain and Nerve, Shinkei Kenkyū No Shinpo
Stephen C Gale, JoAnn Peters, Jason S Murry, Jessica S Crystal, Viktor Y Dombrovskiy
Background: Late middle age (LMA), is a watershed between youth and old age, with unique physical and social changes and declines in vitality, but a desire to remain active despite increasing comorbidity. While post-injury outcomes in the elderly are well studied, little is known regarding LMA patients. We analyzed the injured LMA population admitted to a rural, regional Level 1 Trauma Center relative to outcomes for both younger and older patients. Materials and methods: Our registry was queried retrospectively for patients admitted 7/2008- 12/2015; they were divided into three cohorts: 18-54, 55-65, and >65 years...
March 2018: Annals of Medicine and Surgery
Angela Atinga, Andreas Shekkeris, Michael Fertleman, Nicola Batrick, Elika Kashef, Elizabeth Dick
Major Trauma Centres and Emergency Departments are treating an increasing number of geriatric trauma patients in the UK. Elderly patients, generally defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of geriatric trauma cases is rising yearly, accounting for > 25% of all major trauma cases nationally. The elderly have different physiological reserves and a different response to trauma, due to premorbid frailty, co-existing conditions and prescribed medication...
March 6, 2018: British Journal of Radiology
Navpreet K Dhillon, Joshua Tseng, Galinos Barmparas, Megan Y Harada, Ara Ko, Eric J T Smith, Gretchen M Thomsen, Eric J Ley
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States, especially in the elderly, who have the highest rates of TBI-related hospitalizations and deaths among all age groups. Sepsis is one of many risk factors that is associated with higher mortality and longer length of hospital stay in this population partially due to the immunosuppressive effects of TBI. The significance of early indicators of infection, such as a positive blood, sputum, or urine culture, is not well described...
April 2018: Journal of Surgical Research
Mark Krauthammer, Amir Shuster, Daphna Mezad-Koursh, Benjamin Shlomi, Chaim Stolovitch, Igal Leibovitch
Purpose: To demonstrate an unusual case of orbital trauma due to dental surgery complication. Observations: An elderly patient who underwent dental implantation to the zygomatic bone was hospitalized in the ophthalmology department with impaired abduction of her right eye, also evident on ocular examination. Head computed tomography demonstrated damage to the lateral rectus and to the inferior oblique muscles. Clinical assessment determined these muscles could not be repaired and reattached...
April 2017: American Journal of Ophthalmology Case Reports
Elinore J Kaufman, Ashkan Ertefaie, Dylan S Small, Daniel N Holena, M Kit Delgado
BACKGROUND: Head injury is an increasing contributor to death and disability, particularly amongst the elderly. Older patients are less likely to be treated at trauma centers, and head injury is the most common severe injury treated at non-trauma centers. We hypothesized that patients initially triaged to trauma centers would have lower rates of mortality and higher rates of discharge home without services than those treated at non-trauma centers. STUDY DESIGN: We used the State Emergency Department and Inpatient Databases for six states, 2011-2012 to conduct a retrospective cohort study of patients with severe, isolated head injury...
February 14, 2018: Journal of the American College of Surgeons
Abdullah Bin Zahid, David Balser, Rebekah Thomas, Margaret Y Mahan, Molly E Hubbard, Uzma Samadani
OBJECTIVE Chronic subdural hematoma (cSDH) is a highly morbid condition associated with brain atrophy in the elderly. It has a reported 30% 1-year mortality rate. Approximately half of afflicted individuals report either no or relatively unremarkable trauma preceding their diagnosis, raising the possibility that cSDH is a manifestation of degenerative or inflammatory disease rather than trauma. The purpose of this study was to compare the rates of cerebral atrophy before and after cSDH to determine whether it is more likely that cSDH causes atrophy or that atrophy causes cSDH...
March 2, 2018: Journal of Neurosurgery
Stefano Carbone, Riccardo Mezzoprete, Matteo Papalia, Valerio Arceri, Andrea Carbone, Stefano Gumina
OBJECTIVE: The objectives of the study were: a) to identify osteoporotic proximal humerus fractures in a large consecutive series of patients; b) to identify radiographic fracture patterns among osteoporotic and non-osteoporotic proximal humerus fractures; and c) to calculate intra- and inter-observer reliability of assessment of osteoporosis and of radiographic fracture patterns. METHODS: This was a prospective observational study of patients admitted to the emergency department affected by a proximal humerus fracture between June 2014 and June 2016...
March 2018: European Journal of Radiology
Oktay Gurcan, Ahmet Gurhan Gurcay, Atilla Kazanci, Tuncer Goker, Oguzhan Eylen, Omer Faruk Turkoglu
The Fahr syndrome (FS) is a rare degenerative neurological disorder (its prevalence is <0.5%). FS is distinguished by the presence of abnormal bilateral intracranial calcifications with a predilection for the basal ganglia, also presented by movement disorders such as parkinsonism, paresis, and speech disorders. Chronic subdural hematoma (CSH), which is typically the result of mild head trauma, is a regularly encountered condition in elderly. A 63-year-old man has referred to our clinic from another hospital with a history of mild head trauma approximately a month ago...
January 2018: Asian Journal of Neurosurgery
Rebecca Maria Hasler, Sandra Stucky, Heinz Bähler, Aristomenis K Exadaktylos, Frank Neff
OBJECTIVE: Most deaths occur in the pre-hospital setting, whereas mortality in the emergency department (ED) is low (<1%). However, our clinical impression is that some patients are being transported to hospital in devastating conditions with no likelihood of survival, but demanding extensive hospital resources. The decision on whether to transport a dying person to hospital or not is a difficult task for emergency medical services (EMS) personnel. As there is little epidemiological data about these patients, this paper aims to describe this special population...
2018: PloS One
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