Alterstraumazentren: Anforderungen und Patientenprofil

Zusammenfassung

Alterstraumazentren (ATZ) sind spezialisierte Einrichtungen zur Frakturversorgung bei vulnerablen, älteren Traumapatienten, welche aufgrund oftmals vorhandener Begleiterscheinungen wie Osteoporose, Polypharmazie, Sarkopenie etc. ein erhöhtes Fraktur-/Komplikationsrisiko aufweisen. Die häufigsten Frakturen betreffen das Hüftgelenk, den distalen Radius, den proximalen Humerus, die Wirbelsäule und den Beckenring. Eine zentrale Herausforderung in der Behandlung älterer Patienten ist die ganzheitliche Versorgung sowie die rasche Mobilisierung, da längere Immobilisationsphasen zu einem irreversiblen Muskelmasseverlust und Komplikationen im Behandlungsverlauf mit irreversiblen Funktionseinbußen führen können. Das interdisziplinäre Team in der Versorgung geriatrischer Traumapatienten setzt sich dabei im Wesentlichen aus Orthopäden/Unfallchirurgen, Geriatern, Physio-/Ergotherapeuten, Logopäden, Pflegekräften und Sozialdienstmitarbeitern zusammen. Die vollumfängliche interdisziplinäre Versorgung geriatrischer Traumapatienten kann in Form der sog. geriatrischen Komplexbehandlung umgesetzt werden und hat zum Ziel Begleiterkrankungen wie Herzinsuffizienz, Diabetes mellitus und kognitive Einschränkungen ganzheitlich in der Frakturversorgung mitzubehandeln. Der GBA-Beschluss „hüftgelenknahe Femurfrakturen“ QsFFx von 2021 betont die Notwendigkeit einer schnellen interdisziplinären Versorgung und Mobilisierung nach hüftgelenknahen Femurfrakturen und unterstreicht die zunehmende gesundheitsökonomische Bedeutung einer ganzheitlichen Rehabilitation. In diesem Beitrag werden die Ansprüche an Alterstraumazentren, die Zusammensetzung eines interdisziplinären Teams, typische Patientenprofile und Frakturentitäten sowie die Bedeutung einer raschen schmerzadaptierten Mobilisation bei älteren Frakturpatienten erläutert.

Abstract

Geriatric trauma centers (ATZ) are specialized facilities for fracture care in vulnerable elderly trauma patients, who often have comorbidities such as osteoporosis, polypharmacy, sarcopenia, etc., which increase the risk of fractures and complications. The most common fractures involve the hip joint, distal radius, proximal humerus, spine, and pelvic ring. A central challenge in treating older patients is holistic care and rapid mobilization, as prolonged immobilization can lead to irreversible muscle loss and complications that result in permanent functional impairment. The interdisciplinary team responsible for the care of geriatric trauma patients typically includes orthopedic surgeons, geriatricians, physiotherapists, occupational therapists, speech therapists, nursing staff, and social workers. Comprehensive interdisciplinary care for geriatric trauma patients can be implemented in the form of so-called geriatric complex treatment, aiming to address comorbidities such as heart failure, diabetes mellitus, and cognitive impairments in the context of fracture management. The 2021 GBA directive on “proximal femur fractures” (QsFFx) emphasizes the need for rapid interdisciplinary care and mobilization following proximal femur fractures and highlights the growing health-economic significance of holistic rehabilitation. This article outlines the requirements for geriatric trauma centers, the composition of interdisciplinary teams, typical patient profiles and fracture types, and the importance of rapid, pain-adapted mobilization in elderly fracture patients.

Schlüsselwörter

Alterstraumatologie - Hüftfrakturen - Geriatrische - Komplexbehandlung - Osteoporose - GBA-Beschluss

Keywords

Geriatric Traumatology - Hip Fractures - Geriatric Complex Treatment - Osteoporosis - GBA Directive

Publication History

Received: 08 October 2024

Accepted: 19 November 2024

Article published online:
20 January 2025

• Literatur

• 1 Sambrook PN. et al. Influence of fall related factors and bone strength on fracture risk in the frail elderly. Osteoporos Int 2007; 18: 603-610
• 2 Rupp M. et al The Incidence of Fractures Among the Adult Population of Germany-an Analysis From 2009 through 2019. Dtsch Arztebl Int 2021; 118: 665-669
• 3 Halvachizadeh S. et al. The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center. PLoS One 2021; 16: e0244554
• 4 Liener UCBCRK. Weißbuch Alterstraumatologie. Vol. 1. 2018
• 5 AltersTraumaZentrum DGU. [cited 2020 September 06]; Available from http://www.alterstraumazentrum-dgu.de/de/ueber_uns.html
• 6 Maxwell CA. et al Frailty and Prognostication in Geriatric Surgery and Trauma. Clin Geriatr Med 2019; 35: 13-26
• 7 Mendelson DA, Friedman SM. Principles of comanagement and the geriatric fracture center. Clin Geriatr Med 2014; 30: 183-189
• 8 Haussler B. et al Epidemiology, treatment and costs of osteoporosis in Germany – the BoneEVA Study. Osteoporos Int 2007; 18 p 77-84
• 9 Chandran M. et al Impact of osteoporosis and osteoporosis medications on fracture healing: a narrative review. Osteoporos Int 2024; 35: 1337-1358
• 10 Bekeris J. et al Trends in Comorbidities and Complications Among Patients Undergoing Hip Fracture Repair. Anesth Analg 2021; 132: 475-484
• 11 Hawley S. et al Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study. Age Ageing 2016; 45: 236-242
• 12 Prestmo A. et al Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 2015; 385: 1623-1633
• 13 Holvik K. et al Cause-specific excess mortality after hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). BMC Geriatr 2023; 23: 201
• 14 Lunt EK. et al. The influence of immobility on muscle loss in older people with frailty and fragility fractures. Geroscience. 2024
• 15 Palzer M. et al Acute geriatric treatment of older trauma patients : Influence on mobility, autonomy and postdischarge destination. Z Gerontol Geriatr 2021; 54: 816-822
• 16 Siu AL. et al Effect of inpatient quality of care on functional outcomes in patients with hip fracture. Med Care 2006; 44: 862-869
• 17 Pfeufer D. et al. Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg 2019; 139: 1253-1259
• 18 Bzovsky S. et al Factors Associated With Mortality After Surgical Management of Femoral Neck Fractures. J Orthop Trauma 2020; 34: S15-S21
• 19 Benzinger P. et al Risk of institutionalization following fragility fractures in older people. Osteoporos Int 2019; 30: 1363-1370
• 20 Kanis JA. et al The components of excess mortality after hip fracture. Bone 2003; 32: 468-473
• 21 Rapp K. et al Risk of Nursing Home Admission After Femoral Fracture Compared With Stroke, Myocardial Infarction, and Pneumonia. J Am Med Dir Assoc 2015; 16: 715 e7-715 e12
• 22 Magaziner J. et al Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 2000; 55: M498-M507
• 23 Dyer SM. et al A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016; 16: 158
• 24 Ikpeze TC. et al Distal Radius Fracture Outcomes and Rehabilitation. Geriatr Orthop Surg Rehabil 2016; 7: 202-205
• 25 Neer CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970; 52: 1077-1089
• 26 Kaya N. et al Treatment of Geriatric Proximal Humerus Fractures: Indications and Outcome. Acta Chir Orthop Traumatol Cech 2017; 84: 418-423
• 27 Katthagen JC. et al Cement augmentation of humeral head screws reduces early implant-related complications after locked plating of proximal humeral fractures. Obere Extrem 2018; 13: 123-129
• 28 Kang JR. et al Primary reverse shoulder arthroplasty using contemporary implants is associated with very low reoperation rates. J Shoulder Elbow Surg 2019; 28: S175-S180
• 29 Hu R, Mustard CA, Burns C. Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 1996; 21: 492-499
• 30 Schnake KJ. et al Classification of Osteoporotic Thoracolumbar Spine Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8: 46S-49S
• 31 Henry SM. et al Pelvic fracture in geriatric patients: a distinct clinical entity. J Trauma 2002; 53: 15-20
• 32 Palm HG. et al Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard. Arch Orthop Trauma Surg 2020; 140: 473-480
• 33 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury 2013; 44: 1733-1744
• 34 Krappinger D. et al Inter- and intraobserver reliability and critical analysis of the FFP classification of osteoporotic pelvic ring injuries. Injury 2019; 50: 337-343
• 35 Bundesausschuss G. Beschluss des Gemeinsamen Bundesausschusses über eine Richtlinie zur Versorgung der hüftgelenknahen Femurfraktur. 2019