Orthopaedics
Roy Palmer, Diana Wetherill in Medicine for Lawyers, 2020
There are several types of fracture: open or compoundclosed or simplespiralobliquetransversecomminutedgreensticktraction or avulsioncompressionpathological.
Biocultural Perspectives on Health and Disease
Debra L. Martin, Anna J. Osterholtz in Bodies and Lives in Ancient America, 2015
Fractures in long bones, ribs, and vertebrae are the most frequently reported of the traumatic lesions in the paleopathology literature and the most easily assessed (Walker 2001). Fractures can be classified into a number of categories ranging from micro stress fractures to greenstick breaks to comminuted and complete breaks (Figure 2.6). However, the response of bone to any kind of fracture is the same. There is immediate vascularization and new bone forms within a few days after the break occurs. Calcium salts are released from dead bone fragments and from the living bone and are used in calcifying the callous matrix that forms a binding and connecting sheath around the two fractured ends. Within two weeks, calcification is underway, and the internal remodeling and reorganization of the bone callus begins. The healing process can last for months or years, depending on the age and health of the individual and the severity of the break (Ortner and Putschar 1985). Even a poorly aligned or unaligned bone will eventually mend itself if infection does not interfere with the healing process. The process occurs much more quickly in children than in adults. The union of two bone ends can be complete in four to six weeks in children, while in adults the process may take four or five months (Merbs 1989).
Osteoporosis
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
After age 60, vertebral fractures of the thoracic and upper lumbar spine are common. Vertebral “crush” fractures are a compression or flattening of both the front and back sections of a spinal vertebra. “Wedge” fractures are a compression of just the front part of the vertebra so it resembles a wedge shape. These fractures may occur spontaneously due to decreased bone density or they may be caused by trauma or an accident. Seemingly very minor trauma, particularly that which increases compressive forces on the vulnerable anterior lip of the vertebra may be all that is needed when osteopenia is advanced. Any flexion of the thoracic spine places very large compressive forces on the vertebrae, and if flexion is accompanied by the holding of a heavy mass out in front of the body, the forces will be many times higher. Examples of such mechanically disadvantageous activities for women with osteoporosis include 10-pin bowling and golf swings, which are unfortunately often favorite activities in this population. Vertebral fractures are difficult to document in time because they generally do not involve hospitalization, and are in fact usually asymptomatic. These fractures do heal but the vertebrae cannot return to their original shape as do fractures of other bones such as the arm or leg. Over time, multiple vertebral fractures become evident by a loss of height or kyphotic posture. Painful muscle spasms and feeling of self-consciousness may result from these changes in posture. In severe cases, the lower rib may appear to be resting directly on the iliac crest as several inches of thoracic height are lost, with respiratory symptoms secondary to resultant restrictive lung volumes.
Use of a fracture prevention screening algorithm predicts self-reported falls in postmenopausal women
Published in Physiotherapy Theory and Practice, 2020
Patricia A. Downey, Susan B. Perry, Gregory Marchetti, David P. Thompson
Each woman was provided with a monthly “fall calendar” on which to document falls, fall-related injuries and/or fractures. A fall was defined as an unintentional drop to the ground or floor (Lamb, Jorstad-Stein, Hauer, and Becker, 2005). An injury was defined as any pain, skin abrasion, etc., reported by the participant, whether or not medical intervention was sought. A fracture was defined as a break in any bone that occurred due to the fall. Participants were informed that one of the PI’s would telephone or email them based on their preference each month to inquire about falls/injuries. Individuals were enrolled in the study on a continuous basis. They were contacted monthly for one year by one of the PIs (PD or SP) to ask about falls and any injuries, and to ascertain whether reported falls met the above definition. Such monthly monitoring has been shown to be more effective than asking participants to recall falls over a longer period of time (Lamb, Jorstad-Stein, Hauer, and Becker, 2005). The PIs were blinded to the participant’s risk status at this time. Data collection began in January of 2014 and was completed in May of 2016.
Understanding informal carers’ experiences of caring for older people with a hip fracture: a systematic review of qualitative studies
Published in Disability and Rehabilitation, 2018
Lorena Saletti-Cuesta, Elizabeth Tutton, Debbie Langstaff, Keith Willett
The importance of carers’ role and the impact of caring on the lives of carers have been examined in situations where patients have a range of conditions.[13,14] Much of the literature is in relation to chronic conditions which highlights the structural and contextual factors that impact on carer burden.[15] A fracture of a bone is often a sudden traumatic event requiring acute intervention and/or hospitalization. In older people, a fracture may have a longer-term impact on their experience of daily life and requirement for support.[16,17] Recovery may therefore reflect aspects found in chronic conditions, which compounded by any pre-existing co-morbidities might increase carer burden. Literature in acute care tends to focus on user involvement and engagement in care that identifies a greater need to work with family/carers and include them in decision-making.[18] This is particularly identified in older people [19] and those with reduced capacity such as memory loss.[20]
Development of the annual incidence rate of fracture in children 1980–2018: a population-based study of 32,375 fractures
Published in Acta Orthopaedica, 2020
Andreas V Larsen, Esben Mundbjerg, Jens M Lauritsen, Christian Faergemann
Fractures were defined as any bone damage including epiphyseal fractures (Salter–Harris types), complete fractures, incomplete fractures (bowing fractures, greenstick fractures, and torus fractures), avulsions, and Tillaux/triplane fractures. ICD-8 coding had a specific diagnosis for clinical fractures defined as growth zone tenderness combined with swelling without radiological verification. In the whole study period “clinical fractures” have been considered Salter–Harris type 1 fractures and treated as such. Those “clinical fractures” represented 14% of fractures 1980–1993 in all age groups and were excluded from the study. The ICD-10 coding has no specific diagnosis for “clinical fractures.” However, since the percentages of clinical fractures remained constant through all years in all age groups in the ICD-8 period 1980–93, we assumed that the percentage of “clinical fractures” remained constant in the entire study period. Therefore, we excluded the same proportion of fractures in the ICD-10 period 1994–2018, thereby excluding clinical fractures.