Geriatric traumatology is the interdisciplinary care of older patients with accident-related injuries. It combines three elements:
- Trauma surgery expertise: Surgical care using implants and techniques tailored to osteoporotic bones and multimorbidity.
- Geriatric co-management: Joint medical care starting at admission—delirium prevention, pain management, nutrition, fluid management, medication review, and mobilization planning.
- Structured rehabilitation and secondary prevention: Early rehabilitation starting on the first postoperative day, followed by follow-up rehabilitation and a fall/osteoporosis prevention program.
The model has been significantly expanded in Germany over the past ten years. Certified Geriatric Trauma Centers (ATZ DGU) have defined structural standards—firmly established geriatric co-management, standardized treatment pathways, quality indicators, and regular monitoring.
Injury patterns in older adults differ significantly from those in younger patients. Typical examples include:
- Fractures near the hip: Fractures of the femoral neck and pertrochanteric fractures—together accounting for approximately 150,000 cases per year in Germany.
- Distal radius fracture: A fall onto an outstretched hand. Often the “first warning sign” of osteoporosis in older adults.
- Proximal humerus fractures: Upper arm fractures at the shoulder joint—common in postmenopausal women.
- Vertebral fractures: Often spontaneous or resulting from minimal trauma. Many remain asymptomatic and are only noticed when the person loses height or develops a hunched back.
- Pelvic ring fractures: Particularly common in very elderly women with severe osteoporosis.
- Femoral shaft and peri-implant fractures: More common in patients with existing endoprostheses.
- Fall-related head injuries: High risk, especially in patients on anticoagulant therapy—take every traumatic brain injury seriously in these cases.
At my own clinic, the Main-Kinzig-Kliniken Schlüchtern, femoral neck fractures remain the most common reason for admission to geriatric trauma care. The number of cases has nearly doubled between 2019 and 2025—from 109 to 217 cases per year. This development is in line with the nationwide trend and makes structured orthogeriatric care the rule rather than the exception.
→ The most common and serious fracture in older adults: femoral neck fractures in older adults.
→ On the most common cause of these fractures: Falls in older adults.
→ On the role of osteoporosis as the foundation of fracture risk: Osteoporosis in older adults.
1. Different Outcome Measures
Traditional trauma surgery quality criteria focus on fracture healing, implant stability, and the function of the affected joint. In geriatric traumatology, other objectives are added—some of equal importance, others of primary importance:
- Maintenance or restoration of pre-existing mobility
- Prevention and treatment of delirium
- Return to one’s own home
- Secondary prevention of further fractures
- Quality of life, not just prolonging life
2. A Different Concept of Time
For younger patients, surgery can be postponed by a few days if necessary for organizational reasons. For older patients, the time until surgery is an independent predictor of mortality and complications. The S3 guideline therefore recommends treating fractures near the hip within 24 to 48 hours. For more information, see “Surgical Risk in Older Adults.”
3. A Different Perspective on Complications
The classic complications of trauma surgery—wound infection, implant loosening, and postoperative hemorrhage—are also relevant in older adults, but they take a back seat to other complications that are less common in younger patients:
- Postoperative delirium—30 to 50 percent following a hip fracture
- Pneumonia due to bed rest
- Pressure ulcers
- Urinary tract infection and urosepsis
- Acute renal dysfunction due to fluid and medication-related issues
- Functional decline despite a technically successful surgery — a sign of frailty
4. Different Team Composition
Trauma care for the elderly is not a two-person model (surgeon plus anesthesiologist). It involves a team comprising trauma surgery, geriatrics, anesthesiology, physical therapy, occupational therapy, nursing, social work, speech therapy, and, in some cases, nutritional therapy. Effectiveness stems from collaboration, not from the sum of its parts.
Day 0: Admission and Preparation
- Emergency care provided by the trauma surgery team
- Immediate geriatric co-evaluation—assessment, medication, delirium risk
- Pain management using as few opioids as possible
- Fluid management, ruling out underlying causes of the fall
- Anesthesiological clearance for surgery (regional vs. general anesthesia)
Day 1: Surgery and initial mobilization
- Surgery within 24 hours (no later than 48 hours)
- Mobilization to the edge of the bed on the day of surgery or by Day 1 at the latest
- Delirium screening
- Thrombosis prophylaxis, respiratory therapy, secretion management
Days 2 through 7: Early rehabilitation in the acute care unit
- Gait training with a walking aid
- Occupational therapy for activities of daily living
- Daily orthogeriatric rounds with both teams
- Medication adjustment through deprescribing, secondary prevention, and osteoporosis evaluation
Days 8 through 21: Further rehabilitation and discharge planning
- Follow-up rehabilitation, early geriatric rehabilitation, or discharge home
- Social welfare counseling, provision of assistive devices, home environment modifications
- Transfer letter to the primary care physician with detailed recommendations
→ For information on the geriatric early rehabilitation process: Geriatric Early Rehabilitation.
→ On preoperative risk assessment in older adults: Surgical Risk in Older Adults.
Postoperative delirium is the most common and most serious complication in geriatric traumatology. It is not a secondary phenomenon—it is an independent predictor of mortality, prolonged hospital stays, and loss of independence. The most effective strategy is prevention:
- Early mobilization
- Multimodal pain management with opioid sparing
- Glasses, hearing aids, and dentures kept by the bed
- Encourage the involvement of familiar caregivers
- Adequate hydration and nutrition—particularly important in cases of malnutrition in older adults
- Maintain the day-night rhythm
- Systematic screening using CAM or 4AT
→ For a detailed overview of delirium and delirium prevention: Delirium in Older Adults and Delirium Prevention.
- Ask about the certified Geriatric Trauma Center: The hospital’s structure makes a measurable difference.
- Bring a current list of medications: Include over-the-counter and herbal supplements as well. Keyword: polypharmacy in older adults.
- Provide glasses, hearing aids, dentures, and familiar objects: This reduces the risk of delirium and promotes mobility.
- Visit regularly: Familiar faces have been shown to reduce the risk of delirium.
- Be actively involved in discharge planning: The sooner you’re involved, the smoother the return home will be.
- Ask about osteoporosis screening and secondary prevention: These steps are not optional. More on this: Osteoporosis in older adults.
???? The key question family members should ask: “Does this hospital have a structured geriatric trauma co-management program?” The answer determines the quality of care more than many other factors.
In certified geriatric trauma centers, geriatric co-management is standard. In other facilities—and after discharge—a geriatric perspective is part of good care in the following situations:
- After a hip fracture, if no structured co-management has taken place
- In cases of polypharmacy involving five or more long-term medications
- After multiple falls in older adults over the course of a year
- In cases of pre-existing cognitive impairment or suspected dementia in older adults
- Three to six months after the fracture to evaluate secondary prevention
- In cases of persistent uncertainty, weakness, or suspected frailty syndrome after discharge
→ How the structured geriatric assessment guides further care: Geriatric Assessment.
→ For a systematic fall assessment after the first fracture: Fall Prevention — What Really Works.
