11 GERIATRIC ORTHOPEDICS American （美国11个老年骨科）.pdf

11 GERIATRIC ORTHOPEDICS Susan Day, MD; Robert Karpman, MD* Research on orthopedic management of elderly patients is of critical importance, given the high risk for musculoskeletal disorders among older adults. For a summary of the inci- dence and prevalence of musculoskeletal disorders among adults aged 65 and older, see the opening section of the chapter on geriatric orthopedics in New Frontiers in Geriatrics Research (p. 303). 1 This chapter updates that review of research in geriatric orthopedics, noting for each topic the new research that has been described in the literature. Research in geriatric orthopedics conducted since the publication of New Frontiers suggests no new research topics for the research agenda in this area and no new Key Questions for this specialty. With regard to the Key Questions posed in New Frontiers (see below), there is still much to be learned regarding the influence of aging on fracture healing. Augmentation of fracture healing in aged bone requires further investigation. Techniques of internal fixation have received some study. Locking plates, plates that have screw holes that are threaded which allow screws to lock into the plate, have been shown to be useful in treating fractures when bone quality is poor. They have been shown to be helpful in achieving fracture union with minimal complications in proximal humeral, 2 humeral diaphyseal, 3 and distal radius factures. 4 Randomized clinical trials are needed to compare this method of treatment in other osteoporotic fractures. Ortho KQ1: How can implant fixation in osteoporotic bone be im- proved? Ortho KQ2: How can fracture healing in the aged person be enhanced? Ortho KQ3: How can the outcomes after fracture be optim