Optimizing Surgical Strategies for Lower Limb Fractures in Geriatric Patients: Challenges, Innovations, and Outcomes

Lower limb fractures in geriatric patients represent an increasingly common and complex challenge in orthopedic surgery, driven by population aging, osteoporosis, and the growing incidence of fragility fractures. These injuries, including fractures of the proximal femur, femoral shaft, distal femur, patella, tibia, ankle, and periarticular or periprosthetic regions, are frequently associated with poor bone quality, multiple comorbidities, frailty, limited rehabilitation capacity, and a high risk of morbidity, mortality, and loss of independence. As with hip fractures, outcomes are strongly influenced not only by fracture healing but also by the patient’s ability to regain mobility and functional autonomy as early as possible.Over the past decades, advances in surgical management have improved the treatment of geriatric lower limb fractures. Contemporary fixation options, including locking plate systems, intramedullary nails, augmented fixation techniques, and combined constructs, have expanded the ability to address osteoporotic bone and increasingly complex fracture patterns. However, optimal management remains controversial in many settings, particularly in cases involving severe comminution, periprosthetic fractures, inter-implant fractures, compromised bone stock, or patients with substantial frailty. Achieving stable fixation that permits early mobilization continues to be a central goal and a major challenge in this patient population.To address these limitations, emerging surgical strategies such as dual plating, nail-plate combination constructs, cement augmentation, and other biomechanically enhanced fixation techniques are gaining attention across different anatomical regions of the lower limb. These approaches may improve construct stability, reduce fixation failure, and support earlier weight bearing in selected patients. Early mobilization is especially important in geriatric fracture care, as prolonged immobility or weight-bearing restrictions are often poorly tolerated and may contribute to complications such as delirium, thromboembolic events, pneumonia, muscle wasting, and long-term functional decline.In selected cases, particularly in very frail patients with non-reconstructible fractures, severe bone loss, pre-existing joint degeneration, or failed osteosynthesis, replacement strategies may also represent a valuable alternative. Partial or total joint replacement, as well as megaprosthetic or segmental reconstruction in highly complex cases, may allow immediate mobilization and help avoid complications related to prolonged immobilization, although these approaches also involve greater surgical invasiveness, higher costs, and implant-specific risks.This Research Topic aims to critically evaluate current and emerging surgical strategies for lower limb fractures in geriatric patients, with a focus on orthopedic decision-making, fixation principles, arthroplasty-based solutions, complication profiles, functional outcomes, and mortality. Special emphasis will be placed on fracture-specific surgical planning, biomechanical innovation, early mobilization protocols, and treatment personalization according to frailty, bone quality, and pre-injury functional status. Ultimately, the goal is to support evidence-based surgical management and improve outcomes in this vulnerable and increasingly prevalent patient population. Topic editors: Luigi Zanna, Pietro De Biase, Michele Coviello Source: https://www.frontiersin.org/research-topics/75986/optimizing-surgical-strategies-for-lower-limb-fractures-in-geriatric-patients-challenges-innovations-and-outcomes