Background: Perioperative blood loss represents a major challenge in elderly patients undergoing hip fracture surgery. Although tranexamic acid (TXA) has been shown to reduce bleeding complications, evidence from large registry-based cohorts remains limited. This study assessed the efficacy and safety of perioperative TXA administration in geriatric proximal femoral fracture surgery and evaluated in a subgroup analysis whether repeated TXA administration provides additional benefit compared with a single intraoperative dose. Methods: Data were derived from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU), a prospective multicenter registry of patients aged ≥70 years undergoing surgery for proximal femoral fractures. From a total cohort of 23,830 patients, 1:1 nearest-neighbor matching based on age, sex, America Society of Anesthesiologists (ASA) classification, fracture type, and pre-fracture mobility yielded 3697 patients receiving intraoperative TXA and 3697 controls without TXA. Outcomes included transfusion requirements, thromboembolic events, mortality, reoperation rate, and length of stay. A subgroup analysis compared single-dose intraoperative TXA with combined pre- and intraoperative administration. Results: Intraoperative TXA significantly reduced packed red blood cell transfusion rates compared with controls (44.6% vs. 52.2%; p < 0.001). No significant differences were observed in thromboembolic events, mortality, overall complication rates, or length of hospital stay. Subgroup analysis showed no additional benefit of repeated pre- and intraoperative TXA administration compared with a single intraoperative dose but was associated with a significantly higher incidence of thromboembolic risks in the multiple-dose cohort (3.56% vs. 1.1%; p = 0.038). Conclusions: Intraoperative TXA administration significantly reduces transfusion requirements in geriatric patients undergoing surgery for proximal femoral fractures without increasing thromboembolic complications or mortality. TXA should therefore be considered a safe and effective adjunct in the perioperative management of geriatric hip fracture patients.

Einleitung: Gebrechlichkeit ist ein weit verbreitetes klinisches Syndrom, dass durch eine Beeinträchtigung der physiologische Reserven, beeinträchtigte Kognition und eine erhöhte Prädisposition für ungünstige gesundheitliche Folgen gekennzeichnet ist. Die Clinical Frailty Scale (CFS) ist mittlerweile ein etabliertes Screening-Tool zur Vorhersage der Gebrechlichkeit, auch bei Patienten mit hüftgelenksnahen Frakturen. In diesem Zusammenhang wurde die Vorhersagekraft der CFS auf die Mortalität, die Verweildauer und die Rückkehr in die häusliche Umgebung nachgewiesen. In dieser Auswertung aus dem Alterstraumaregister, möchten wir ergänzend die Vorhersagekraft auf weitere Outcomeparameter, wie die Mobilisation, den EQ5D, chirurgische und nicht-chirurgische Komplikationen hin untersuchen. Methode: Insgesamt lagen von 29.347 Patienten aus 170 Alterstraumazentren Daten bzgl. der CFS vor. Diese Auswertung beschränkt sich auf die Jahre 2022-2024. Eingeschlossen in das AltersTraumaRegister werden Patienten≥70 Jahre, die operativ auf Grund einer proximalen oder periprothetischen/periimplantären Femurfraktur versorgt wurden. Neben den Baselinecharakteristika werteten wir behandlungsrelevante Daten für den Behandlungsverlauf und das Outcome aus. Ergebnisse: 57% (n=16.584) Patienten wiesen einen CFS≥ 5 auf und galten somit als frail. Im Vergleich zu Patienten, die nicht als frail eingeschätzt wurden zeigte sich bei frail einschätzten Patienten ein höherer ASA-Score, schlechtere Gehfähigkeit (selbstständig gehfähig (17%vs59%), häufigere Heimunterbringung (30%vs.5%), erhöhte Rate an Delir bei Aufnahme (32%vs.10%). Auch im Outcome während des stationären Aufenthaltes zeigte sich bei Patienten mit positivem CFS eine verminderte Gehfähigkeit (70%vs.89%), erhöhte Rate an nicht chirurgischen Komplikationen (47%vs.35%), vergleichbare Rate an Revisionsoperationen (3%), vermehrte Entlassung in ein Heim (39%vs.14%), ein verminderter EQ5D (0,42vs.0,69), kürzere Verweildauer (15vs.16 Tage) und eine erhöhte Mortalität (8%vs3%). Auch im 120 Tage Follow-up stellt sich dies ähnlich dar. Diskussion: Mit 57% wird über die Hälfte der Patienten mit hüftgelenksnahen Frakturen als Frail eingeschätzt. Die CFS eignet sich hierbei Patienten, welche gebrechlich sind, einfach zu identifizieren. Wir konnten nachweisen, dass Patienten mit einer CFS≥5 ein erhöhtes Risiko für nicht chirurgische Komplikationen, schlechtere Mobilität nach 7 Tagen und einen verminderten EQ5D aufweisen. Zudem konnten wir die bereits in der Literatur beschriebene Vorhersagekraft auf den Ort der Entlassung und die Mortalität bestätigen. Diese Unterschiede persistieren auch im 120 Tage Follow-up. Insbesondere die Mortalität weist mit 15% vs. 5% ein deutlich erhöhtes Risiko auf. Zudem weisen Patienten mit einer CFS≥5 ein nahezu doppelt so hohes Risiko für eine contralaterale Femurfraktur auf (1,2%vs.0.7%). Korrespondenzadresse: Tom Knauf, Helios Kliniken Kassel, Unfallchirurgie, Hansteinstraße 29, 34121 Kassel, Deutschland, E-Mail: tom.knauf@helios-gesundheit.de Article published online: 23 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Background: The decision of the Joint Federal Committee on the treatment of hip fractures stipulates that proximal femur fractures must be treated within the first 24 h. This leads to organizational and personnel difficulties in day-to-day care. Therefore, we investigated the question at what times of day we operate to maintain this timeline and whether there is a difference in the outcome for the patients according to treatment hours. Methods: Data from the DGU’s “AltersTraumaRegister” from 2016 to 2020 were analyzed. For the analysis, the patients were divided into seven cohorts depending on the time of surgery. Pre-operative, operative, and follow-up data were analyzed. Results: A total of 29,470 patients were included in our study. The results showed that 74% of patients were treated within 24 h. 72% of patients operated on between 0–7 h had pertrochanteric fractures, while 56% of all arthroplasties were performed during normal working hours. In supra-regional trauma centers, significantly fewer operations were performed during normal working hours, while significantly more surgeries were carried out in the late evening and at night (p < 0.001). There were no significant differences in mortality and morbidity between the individual groups. Conclusions: Although we manage to treat most patients within 24 h, only 46% of patients are operated on within normal working hours. In terms of the outcome parameters, this does not appear to be a disadvantage for the patients. Nevertheless, night work and fatigue affect concentration and post-operative results in many areas, as we know. Consequently, patient care during normal working hours within 24 h creates the best possible initial situation for the patient, as significantly more personnel resources are available during normal working hours. The aim should be to create the logistical and personnel requirements for this.

Background: Geriatric trauma centers (ATZ) in Germany provide interdisciplinary care for elderly trauma patients with the objective of enhancing treatment outcomes following proximal femur fractures. Delirium, a prevalent and grave complication in this patient population, has been associated with elevated mortality and functional limitations. The objective of this study was to examine the prevalence and consequences of delirium in proximal femur fractures by utilizing the Registry for Geriatric Trauma (ATR-DGU). Methods: The study encompassed 32,934 patients aged ≥70 years who sustained proximal femoral fractures during the period 2022–2023. The demographic and clinical parameters, fracture type, time of surgery, mobility, complications, and mortality were meticulously documented. The primary endpoint of the study was the occurrence of delirium and its influence of the outcome of hip fracture patients. Additionally an analysis was conducted to account for peri-implant/periprosthetic fractures. Results: Of the 21,127 patients who underwent screening, 23.6% had already been diagnosed with delirium upon admission. The delirium rate did not differ between hip-/pertrochanteric and peri-implant/periprosthetic fractures. Patients in a delirious state were found to be older, frailer, and more dependent on care. They exhibited more non-surgical complications, poorer mobility, and more frequent transfers to nursing homes. In the context of peri-implant/periprosthetic fractures, delirium showed no significant difference regarding surgical revision (p = 0.192) and mortality rates (p = 0.229). Conclusions: Delirium is therefore a prevalent and clinically significant complication. Its early detection and prevention are essential for proximal femur fracture patients in orthogeriatric care.