Fracture Management in Chronic Kidney Disease: Challenges and Considerations for Orthopedic Surgeons
Wan Kee Hong1, Sejoong Kim2, Hyun Sik Gong1
1Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Insights
Managing fractures in patients with chronic kidney disease (CKD) requires careful perioperative and medical strategies. Addressing comorbidities and optimizing bone health is crucial for improving outcomes in these high-risk individuals.
Area of Science:
- Nephrology
- Orthopedic Surgery
- Bone Metabolism
Background:
- Chronic kidney disease (CKD) affects millions globally and is linked to increased fracture risk due to osteoporosis.
- Fractures in CKD patients present unique challenges, including impaired bone healing and higher complication rates like infection and nonunion.
Purpose of the Study:
- To outline key considerations for orthopedic surgeons managing fractures in patients with CKD.
- To provide guidance on perioperative and long-term medical management strategies.
Main Methods:
- Review of factors influencing fracture treatment in CKD patients.
- Discussion of perioperative management, including dialysis, anesthesia, and bleeding risks.
- Recommendations for pain management and post-fracture medical care.
Main Results:
- CKD patients have elevated fracture risk and impaired healing.
- Perioperative care requires tailored approaches to dialysis, anesthesia, and cautious tourniquet use.
- Opioids are preferred over NSAIDs for pain management; rehabilitation is vital.
Conclusions:
- A comprehensive, multidisciplinary approach is essential for optimal fracture management in CKD patients.
- Careful attention to comorbidities and individualized treatment plans can mitigate complications and improve patient outcomes.
Abstract:
Orthopedic surgeons treating fractures need to consider comorbidities, including chronic kidney disease (CKD), which affects millions worldwide. CKD patients are at elevated risk of fractures due to osteoporosis, especially in advanced stages. In addition, fractures in CKD patients pose challenges due to impaired bone healing and increased post-fracture complications including surgical site infection and nonunion. In this article, we will discuss factors that must be considered when treating fractures in CKD patients. Perioperative management includes careful adjustment of hemodialysis schedules, selection of anesthetic methods, and addressing bleeding tendencies. Tourniquet usage for fractures in limbs with arteriovenous fistulae should be cautious. Pain medication should be administered carefully, with opioids like hydromorphone preferred over nonsteroidal anti-inflammatory drugs. Medical management after fractures should address underlying factors and include physical rehabilitation to reduce the risk of subsequent fractures. A comprehensive approach to fracture management in CKD patients can improve outcomes.
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