Author/Editor     Komadina, Radko
Title     Ortogeriatrično soupravljanje v priporočilih ESTES 2015 za zdravljenje zloma kolka
Translated title     Ortho-geriatric co-management in ESTES recommendations for hip fracture treatment 2015
Type     članek
Source     In: Monografija V. osteoloških dnevov z mednarodno udeležbo Maribor : Univerzitetni klinični center
Publication year     2015
Volume     str. 147-151
Language     slv
Abstract     Evropsko združenje za travmatologijo in urgentno kirurgijo (ESTES) je na kongresu 2015 sprejelo priporočila za evropske države za zdravljenje zloma kolka pri starostnikih. Upoštevajo krhkost starostnika kot zmanjšanje kompenzatornih fizioloških mehanizmov za ohranjanje homeostaze. Priporočila presegajo običajni kirurški okvir, saj priporočajo timsko obravnavo starostnika v sodelovanju različnih zdravnikov in drugih zdravstvenih delavcev, da bi dosegli čim krajšo hospitalizacijo in čim prejšnjo povrnitev starostnika v njegovo domače okolje ter dosegli takšen gibalni standard, kot ga je imel pred doživetim zlomom. Priporočila vključujejo ortogeriatrično soupravljanje kot primer procesne reorganizacije kirurškega zdravljenja (fast track surgery, ERAS).In Europe, osteoporosis causes a fracture every 30 seconds. Every fifth woman and every eighth man will experience one of the typical osteoporotic fractures in their lifetime. To neglect the treatment of underlying disease (osteoporosis) would be a medical error, vitium artis. Treatment of hip fractures passed through nihilistic-fatalistic phase, conservative phase, in 1858 Langenbeck's first osteosynthesis of neck fracture, introducing Smith-Petersen nail mortality reduced from 75 to 28 %, introduction of new technologies enabled some improvement, but new paradigm (the fragility fracture is an injury and a disease at the same time) resulted in orthogeroatric co-management. Orthogeriatrics describes various forms of structural cooperation between orthopedic surgeons and a multiprofessional geriatric team. It is country specific with 4 types of the possible process reorganization (permanent or on call orthop. trauma surgeon or geriatritician), but with no clear recommendations how this should be organized. Only a few randomized controlled trials of early orthogeriatric treatment have been performed and these trials are of limited quality. Orthogeriatric surgeons are hardly willing to accept their responsibility for osteoporosis treatment due to lack of familiarity with the initiation of a specific drug treatment. FLS (fracture laison service) is one of the options in the field of post-fracture care to improve the medical management of osteoporosis. Hospitalization for hip frx may represent an oportunity in identifying high-risk patients with osteoporosis and hence to initiate appropriate treatment. In co-management care lenght of stay was significantly shorter and patients were less likely to experience a complication while beeing in the hospital. There was no significant differences in 1-year mortality or in the change of residential status. ESTES Recommendations for hip frx treatment advise to restore the level of prefrx activity as the main treatment goal. To reach this goal a multidisciplinary approach is necessary with at least a trauma (orthop.) surgeon, anesthesiologist and geriatritian involved, including fast track principle, management of pain, decubitus, delirium, fluid (water and electrolyte) management, anticoagulant drugs, malnutrition, early mobilization, etc. According to Masud's MIPPs in late 90s contemporary post fall and post fracture strategy is focused towards multifactorial interventions with osteoporosis and sarcopenia treatment. Lean mass DXA measurement correlates with body composition DXA scans and depists the muscle mass loss. Osteosarcopenia in frailty elderly poly-morbid patient with fragility fracture should be determined. Identification of recent fallers and fall prevention programs should be organized on the national level.