[Fracture management in elderly patients. A technically and ethically challenging responsibility]

The accident surgeon is increasingly being confronted with typical fractures of old age. These differ from those seen in other phases of life in that they characteristically occur in a situation of reduced mental performance, and coordination, and are associated with structural bone weakness. Also typical is the fact that there is usually no external causal factor involved. Many patients are polymorbid. Treatment of lower-limb fractures concentrates on early re-mobilization. Uncontrolled full weight bearing cannot be avoided, and medullary nailing is therefore preferable to plating. In the case of comminuted fracture of the humerus head or medial femoral head fractures, the chances of reconstruction with preservation of bone vitality are poor and the use of an endoprosthesis permits early functional recovery. Rehabilitation facilities tailored to the needs of elderly trauma patients are required. In the acute trauma unit, the increasing demands being made by geriatric trauma care make staff and structural changes necessary.