CHALLENGES AND OPTIONS IN THE TREATMENT OF FEMORAL FRACTURES IN THE ELDERLY: AN INTEGRATIVE LITERATURE REVIEW

Resumo

Femoral fractures in the elderly pose a significant challenge to public health. This integrative
literature review shows that older patients with proximal femur fractures face numerous
difficulties, including high mortality rates, adverse events, and limited mobility recovery.
Advanced age and frailty emerge as significant risk factors for unfavorable outcomes, resulting
in high morbidity, mortality, and associated costs. Furthermore, most of these elderly
individuals become institutionalized, experiencing significant mobility loss and decreased
independence in daily activities. The choice between surgical and non-surgical treatment is
complex and involves multiple factors, such as life expectancy, quality of life, costs, and patient
preferences. In this perspective, the aim of this study is to analyze different management
strategies and their respective prognoses for femur fractures in elderly patients. This
integrative review was conducted through searches in the Public Medicine database and the
Virtual Health Library, using various combinations of Health Science Descriptors, such as
"Femoral Fractures," "Frail Elderly," and "Prognosis." Inclusion criteria encompassed free
original articles published within the last 5 years and written in English. Texts unrelated to the
research theme or objective were excluded. It was analyzed six studies related to the treatment
of proximal femur fractures in elderly and frail patients, covering various clinical aspects, costs,
and multidisciplinary co-management protocols. Regarding treatment options, the choice
between surgical and non-surgical treatment must be carefully considered. While surgical
treatment may lead to a slight improvement in the quality of life, the associated costs are
significantly higher, raising questions about cost-effectiveness. Additionally, the importance of
shared decision-making and the careful selection of patients are emphasized. The involvement
of specialists in geriatric care is crucial in the treatment decision-making process. Other studies
explored implant options for non-displaced femoral neck fractures, such as the triple screw
construct and dynamic hip screw, which showed similar prognoses, and the femoral neck
system, which appeared promising in terms of surgical time and resistance to shearing forces.
However, all treatment methods resulted in some fracture impaction and proximal femur
shortening, suggesting the need for further research to confirm these findings. Furthermore,
an observational study pointed to lower mortality rates in patients with distal femur fractures
who underwent total knee arthroplasty, especially among younger patients. This finding may
influence treatment approaches in specific cases. From another perspective, multidisciplinary
co-management proved effective in reducing the average hospitalization time, decreasing
inpatient medical expenses, and reducing mortality. However, the long-term impact on medical
expenses was not statistically significant, emphasizing the need for additional studies with
larger samples and longer observation periods. In conclusion, this integrative review provides
a comprehensive overview of the challenges and treatment options for elderly patients with
proximal femur fractures. Treatment choices should consider not only clinical outcomes but
also costs, patient preferences, and individual characteristics such as age, frailty, and life
expectancy. Multidisciplinary approaches and shared decision-making play a crucial role in
improving prognosis and managing costs related to this type of injury.