gms | German Medical Science

Objectives: Starting a comanaged orthogeriatric fracture unit is challenging for team play, administrative procedures and knowledge transfer for the involved orthopaedic and geriatric clinic and their teams.

We want to analyse the our patients and compare the data to the literature.

Methods: From 02/15 to 07/15 all patients with a fracture aged >70 with >2 comorbidities were screened using the the modified triage risk screening tool (TRST) and included with >2 of 5 points. Patients > 80 presenting with a fracture were generally included. Patients with no rehab potential were excluded.

Included patients were either directly referred form the emergency department to our new othogeriatric fracture unit or were transferred there after surgery. Treatment included daily interdisciplinary rounds, a coownership of the patients, no postoperative transfer or change of the caring doctors, nurses or therapists. We categorized the injuries leading to hospitalization, the complication (Clavien-Dindo), the time to surgery, the length of hospitalization, the 30 day mortality and the discharge location and compared our results to those found in the literature.

Result: 97 patients were seen in the eligible time period and 72(74%) met the inclusion criteria. 13(13%) didn't meet the inclusion criteria and 12(13%) met the criteria but could not be included for lack of capacity on the unit.

Mean age of the included patients was 84 years (range 70-100). 58(81%) had a fracture of the proximal femur region. 11(15%) patients went directly (<6h between admission and surgery) to the OR. The mean time to surgery was 19(4-66) hours, 49(68%) were operated within 24 hours. The mean length of stay was 15(8-22) days. No complication was seen in 56%. 6% had a grade I complication according to Clavien-Dindo, 29% grade II, 3% grade III, 0% grade 4 and 6% grade 5. 12% of the patients returned directly home, 72% were discharged to a rehabilitation unit, 4% were newly discharged to a nursing home and 13% returned there. Readmission rate was 4% within 6 months and the 30 day mortality was 6%.

Conclusion: Introducing a geriatric fracture unit was challenging and involved various medical departments, professional teams and medical as well as administrative aspects.

Anyhow our results are comparable with the published data in literature and patient safety was granted. The high percentage of included patients shows the importance of this program for the elderly patients. With more capacity we could have included even more patients.