Modern approaches to the treatment of proximal femur fractures in elderly patients: a literature review

The treatment of proximal femur fractures in elderly and senile patients remains one of the most pressing problems in modern traumatology and geriatrics. The high incidence of this pathology, the severe condition of patients characterized by polymorbidity, frailty, and cognitive impairment, as well as significant mortality rates, determine the medical and socioeconomic importance of the problem. This review, based on the analysis of domestic and foreign literature, examines the key aspects of PFF treatment in geriatric patients. A historical overview of the development of surgical approaches is presented. The role of conservative methods, which are currently used only as a forced alternative in strictly limited clinical situations, is analyzed in detail. Special attention is paid to the modern principles of preoperative preparation, based on early surgical intervention (within 48 h), comprehensive geriatric assessment, and a multidisciplinary approach. Modern surgical technologies for the treatment of trochanteric fractures and femoral neck fractures are discussed, including a differentiated approach to choosing the method of osteosynthesis or arthroplasty. A significant part is devoted to the analysis of intra- and postoperative complications, risk factors for their development, and prevention methods. The critical importance of early mobilization, nutritional support, and staged rehabilitation is emphasized. Promising directions for improving care are considered, including the development of the orthogeriatric approach, the creation of fracture liaison services, and the introduction of digital technologies.

1. Fischer H, Maleitzke T, Eder C, et al. Management of proxi-mal femur fractures in the elderly: current concepts andtreatment options. Eur J Med Res. 2021;26(1):86.https://doi.org/10.1186/s40001-021-00556-0

2. Seryapina YuV, Fedyaev DV, Musina NZ. Analysis of demographic, social and economic effects of the introduction ofsurgical treatment for proximal femur fractures in geriatricpatients in the Russian Federation. Russian journal of geriatric medicine. 2021;2(6):201–210. (In Russ.)https://doi.org/10.37586/2686-8636-2-2021-191-200

3. Ishchuk DE, Peshekhonov EV. Changing views on the treatment and rehabilitation of elderly and senile victims with femoral neck fractures. Hospital medicine: science and practice.2019;1(4):14-20. (In Russ.) https://www.elibrary.ru/ulerqh

4. Voitovich AV, Shubnyakov II, Abolin AB, et al. Treatment ofpatients with fractures of the proximal femur. Traumatologyand orthopedics of Russia. 1996;3:29–31. (In Russ.)https://www.elibrary.ru/ynyrrq

5. Pass B, Schoeneberg C. Konservative Frakturversorgung beialten Menschen. Z Gerontol Geriatr. 2024;57(4):321–329.https://doi.org/10.1007/s00391-024-02314-3

6. Nurlygayanov RZ, Gilmutdinova LT, Gilmutdinov BR, et al.Medical rehabilitation of patients with proximal femur fracturesduring conservative treatment: a modern solution to the problem. Medicine. Sociology. Philosophy. Applied Research.2025;1:136–141. (In Russ.) https://www.elibrary.ru/nwfhsp

7. Korshnyak VYu, Rykov AG, Volovik VE, et al. Results of conservative treatment of femoral neck fractures in patients ofthe older age group. Healthcare of the Far East.2008;6(38):41–42. (In Russ.) https://www.elibrary.ru/vodxvr

8. Tkacheva ON, Naumov AV, Kotovskaya YuV, et al. Chronicpain in elderly and senile patients. Clinical guidelines. Rus-sian Journal of Geriatric Medicine. 2021;3:275–320. (InRuss.) https://doi.org/10.37586/2686-8636-3-2021-275-312

9. Murzabekov IA, Tautiev NKh, Uzhakhova ZM, ArsamakovAZ. Rehabilitation treatment of patients with proximal femurfractures in elderly and senile age. In: Collection of scientificworks of the Ingush State University. Magas: 2007. p. 170–177.(In Russ.)

10. Loggers SAI, Van Lieshout EMM, Joosse P, et al. Prognosisof nonoperative treatment in elderly patients with a hip fracture: A systematic review and metaanalysis. Injury.2020;51(11):2407–2413. https://doi.org/10.1016/j.injury.2020.08.027

11. Lyadova MV, Chulovskaya IG, Lyadova AV. Current conceptof treatment of geriatric patients with proximal femur fractures (clinical, medical-legal and social aspects). RussianJournal of Geriatric Medicine. 2021;2:230–235. (In Russ.)https://doi.org/10.37586/2686-8636-2-2021-220-225

12. Garifullov GG, Burmistrov MV, Khabibyanov RYa, et al. Theinfluence of the timing of surgical treatment of elderly andsenile patients with proximal femur fractures on one-yearpostoperative mortality. In: Actual problems of diagnosis and treatment of diseases and injuries of the musculoskeletal system. Kazan: 2019. p. 26–28. (In Russ.)

13. Dubrov VE, Shelupaev AA, Arutyunov GP, et al. Proximal femur fractures. Clinical picture, diagnosis and treatment (Clinical guidelines, abridged). Bulletin of Traumatology and Orthopedics N. N. Priorov. 2021;28(4):49–89. (In Russ.) https://doi.org/10.17816/vto100763

14. Sharashkina NV, Tkacheva ON, Runikhina NK, et al. Comprehensive geriatric assessment — the main tool of a geriatrician. Russian Journal of Geriatric Medicine. 2022;4(12):210–227. (In Russ.) https://doi.org/10.37586/2686-8636-4-2022-210-227

15. Solomyannik IA, Galeeva ZhA, Aleksanyan LA. Multidiscipli-nary approach in geriatric practice. Russian Journal of Geri-atric Medicine. 2025;3(23):310–320. (In Russ.) https://doi.org/10.37586/2686-8636-3-2025-310-320

16. Sidorenko AE, Kabanov MYu, Polikarpov AV. Interdisciplinary approach in the treatment of proximal femur fractures in elderly patients. Advances in Gerontology. 2022;35(4):632. (In Russ.) https://www.elibrary.ru/ojonty

17. Kavalersky GM, Chensky AD, Prokhorova MYu. Risks of surgical interventions in patients with proximal femur fracture in elderly and senile age. Department of Traumatology and Orthopedics. 2014;4:9–19. (In Russ.) https://www.elibrary.ru/umsedr

18. Petrov NV, Kavalersky GM, Chensky AD, Prokhorova MYu. Assessment of surgical risks in elderly and senile patients with a proximal femur fracture. Department of Traumatology and Orthopedics. 2016;(Special Issue):54. (In Russ.) https://www.elibrary.ru/xwfmwz

19. Shitova VI. Optimization of treatment of elderly patients with osteoporosis in fractures of the proximal femur. In: Mechnikov Reading–2023. St Petersburg: 2023. p. 628–629. (In Russ.)

20. Lesnyak OM, Kochish AYu, Belenky IG, et al. Interdisciplinary consensus on the management of elderly patients with proximal femur fractures based on the orthogeriatric approach. Russian Journal of Geriatric Medicine. 2025;2(22):90–114. (In Russ.) https://doi.org/10.37586/2686-8636-2-2025-90-114

21. Gevorkyan AM, Moskalenko VV, Prokopovich VD. Pre- and intraoperative features of anesthesia in elderly patients with proximal femur fractures. Advances in Gerontology. 2022;35(4):587–588. (In Russ.) https://www.elibrary.ru/uvllyn

22. Bökeler U, Bühler A, Eschbach D, Ilies C, et al. The influence of a modified 3rd generation cementation technique and vacuum mixing of bone cement on the bone cement implantation syndrome (BCIS) in geriatric patients with cemented hemiarthroplasty for femoral neck fracture. Medicina. 2022:58(11);1587. https://doi.org/10.3390/medicina58111587

23. Schuetze K, Burkhardt J, Pankratz C, et al. Is new always better: comparison of the femoral neck system and the dynamic hip screw in the treatment of femoral neck fractures. Arch Orthop Trauma Surg. 2023;143(6):3155–3161.

24. https://doi.org/10.1007/s00402-022-04551-w

25. Voronina NV. Improving geriatric care in the context of the implementation of the national project "Older Generation". Bulletin of Public Health and Healthcare of the Russian Far East. 2024;(2(55)):5–19. (In Russ.) https://www.elibrary.ru/ugtvuy

26. Cheng WJ, Ding GZ, Gong YH. Analysis of risk factors of perioperative blood transfusion in the treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation. Zhongguo Gu Shang. 2021;34(8):755–758. https://doi.org/10.12200/j.issn.1003-0034.2021.08.012

27. Vorobyov AS, Bashkireva AS, Baranova NP, et al. Innova-tive gerontechnology in the treatment and early rehabilitationof elderly and senile patients with a proximal femur fracture.In: Rehabilitation — XXI Century: Traditions and Innovations. St Petersburg: 2021. p. 324–329. (In Russ.)

28. Fedulichev PN, Zadnepryany IV, Meshcheryakova AV, et al.Risk of complications in the treatment of proximal femur fractures in patients in the age aspect. Operative Surgery andClinical Anatomy (Pirogov Scientific Journal). 2022;6(1):34–38. (In Russ.) https://doi.org/10.17116/operhirurg2022601134

29. Zavyalov BG, Karchebny NN, Solodky VP, Panin MA. Long-term results of surgical treatment of senile patients with trochanteric femur fractures. Moscow Medicine. 2019;2(30):71–72. (InRuss.) https://www.elibrary.ru/pbotqm

30. Goodnough LH, Wadhwa H, Tigchelaar SS, et al. Indications for cement augmentation in fixation of geriatric intertrochanteric femur fractures: a systematic review of evidence. Arch Orthop Trauma Surg. 2022;142(10):2533–2544. https://doi.org/10.1007/s00402-021-03872-6

31. Boukebous B, Biau D, Gao F. AtoG: A simple score to predictcomplications and death after hip fractures, in line with the comprehensive geriatric assessment. Orthop Traumatol Surg Res.2024;110(3):103827.https://doi.org/10.1016/j.otsr.2024.103827

32. Pass B, Malek F, Rommelmann M, et al. The Influence of Malnutrition Measured by Hypalbuminemia and Body Mass Index on the Outcome of Geriatric Patients with a Fracture of the Proximal Femur. Medicina. 2022;58(11):1610. https://doi.org/10.3390/medicina58111610

33. Popp D, Stich-Regner M, Schmoezl L, et al. Predictive feasibilityof the graz malnutrition screening, controlling nutritional statusscore, geriatric nutritional risk index, and prognostic nutritionalindex for postoperative long-term mortality after surgically treated proximal femur fracture. Nutrients. 2024;16(24):4280.https://doi.org/10.3390/nu16244280

34. Tkatch L, Rapin CH, Rizzoli R, et al. Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. J Am Coll Nutr. 1992;11(5):519–525. https://doi.org/10.1080/07315724.1992.10718256

35. Luzina AV, Arefieva AA, Runikhina NK. Physical rehabilitation in geriatric practice. Problems of Geroscience.2025;2:54–59. (In Russ.) https://doi.org/10.37586/2949-4745-2-2025-54-59

36. Berezina VV. Methods of physical rehabilitation of non-operated geriatric patients after femoral neck fracture. In: Placeand role of physical culture in the modern world. St. Petersburg: 2022. p. 34–40. (In Russ.)

37. Bökeler U, Liener U, Schmidt H, et al. Intensive Multiprofessional Rehabilitation Is Superior to Standard OrthogeriatricCare in Patients with Proximal Femur Fractures — A Matched Pair Study of 9580 Patients from the Registry for Geriatric Trauma (ATR-DGU). J Clin Med. 2024;13(21):6343.https://doi.org/10.3390/jcm13216343

38. Arefieva MS, Eruslanova KA, Runikhina NK, et al. Rehabilitation programs for elderly surgical patients in the postoperative period. Russian Journal of Geriatric Medicine.2023;4:261–272. (In Russ.) https://doi.org/10.37586/2686-8636-4-2023-261-272

39. Blauth M, Joeris A, Rometsch E, et al. Geriatric fracture centrevs usual care after proximal femur fracture in older patients:what are the benefits? Results of a large international prospec-tive multicentre study. BMJ Open. 2021;11(5):e039960.https://doi.org/10.1136/bmjopen-2020-039960

40. Belova KY, Ershova OB, Gordzheladze KhG. Long-term follow-up of patients in fracture liaison services: problems andsolutions (literature review and own data). Osteoporosis andOsteopathies. 2022;25(4):11–20. (In Russ.) https://doi.org/10.14341/osteo12952

41. Khovasova NO, Dudinskaya EN, Naumov AV, et al. Effect ofbone anabolic therapy on bone remodeling parameters and bone density in geriatric patients with osteoporosis and falls syndrome. Problems of Endocrinology. 2022;68(3):67–75. (In Russ.) https://doi.org/10.14341/probl13079

42. Marsault LV, Ryg J, Madsen CF, et al. objectively measuredphysical activity and its association with functional independence, quality of life and inhospital course of recovery in elderly patients with proximal femur fractures: a prospectivecohort study. Rehabil Res Pract. 2020;2020:5907652.https://doi.org/10.1155/2020/5907652