Monday, August 21, 2017

Different Types of Fractures

Certain types of fractures are more commonly associated with
osteoporosis and other bone diseases. In this section we define
these common fracture types and the difficulties they can cause.

Falling on outstretched arms

Wrist fractures, often called Colles’ fractures, typically occur as a
result of osteoporosis. These breaks usually happen in the radius,
Chapter 7: Facing the Consequences of Bones Gone Bad 109
the ulna, or some of the other small bones in your wrist (see Figure
7-1). Colles’ fractures often occur when you fall and put your
arm out to break your fall.

Figure 7-1: A wrist or Colles’ fracture is very common in people with osteoporosis.
Darker lines show where the wrist might break.
Treatment requires casting or some other form of immobilization.
Sometimes you may require surgery. You may experience loss of
motion of your wrist, but this type of fracture isn’t nearly as devastating
as a hip or spinal fracture.

However, the occurrence of a wrist fracture is clearly a warning
sign that you may have an overall reduction in the strength of your
bones. A Colles’ fracture is therefore considered a fragility fracture,
and your doctor needs to evaluate you for the possibility of osteoporosis
or other bone disorders.

Who are more prone to wrist fractures? Among American women,
the incidence of wrist fractures increases rapidly at the time of
menopause and plateaus at about 700 per 100,000 persons per year
after age 60.
Wrist
fractures
110 Part III: Diagnosing and Treating Osteoporosis
“I broke my hip! Or was it
my femur?”
What is commonly referred to as a “broken hip” is actually a fracture
of the femur, the longest and heaviest bone in your body. The
fracture is usually found at the neck of the femur, where it connects
to the pelvis.

More than 300,000 people fracture their hip each year in the United
States. In fact, hip fractures (see Figure 7-2) are the second most
common type of osteoporotic fracture.

Figure 7-2: A “hip fracture” is actually a fracture of the femur, oftentimes in the
femoral neck, which is an area that is particularly weak.

Ninety percent of all hip fractures are related to osteoporosis. Hip
fractures are devastating and can have long-term consequences. A
hip fracture
Requires a trip to the emergency room. In the United States,
in 1995, hip fractures resulted in 800,000 visits to emergency
rooms.
Requires hospitalization with period of immobility. In 2003,
in the United States, there were 300,000 hospital admissions
for hip fracture (defined as a fracture of the head of the
Hip
fractures
Chapter 7: Facing the Consequences of Bones Gone Bad 111
femur) in one year. There could be more fractures not
included in this analysis.

Often requires surgery. You need a new hip or a pin in your
hip. (See Chapter 13 for more details about the surgery after
hip fractures.) Surgery on your hip can be complicated by
very serious problems including infection, pneumonia, and
blood clots in your legs or lungs.

Fractures of the femoral neck are very close to the hip joint.
As a result, doctors can’t immobilize this area with a cast.
In addition a hip fracture can lead to
Increased disability from hip surgery. One-fourth of all people
with a hip fracture become disabled in the year after their
fracture. Hip fractures result yearly in more than 7 million
days of reduced activity.

Increased chance of ending up in a long-term care facility.
Almost 75 percent of all nursing home admissions are related
to hip fractures from osteoporosis, which accounts for
approximately 6,000 admissions yearly. Almost half the
expense of hip fracture healthcare is paid to nursing homes.
(In 1995, 180,000 people ended up in a chronic care facility
because of a hip fracture.)

Reduced life expectation. Hip fracture affects your health and
ability to care for yourself (your risk of dying even!).
If you were able to get around without a walker or other aid at
the time of your hip fracture, fracturing you hip will almost
triple (2.8 times) your risk of dying in the next three months,
compared to people who don’t have a fracture.

According to one study of women older than 65, each standard
deviation decrease in bone density at the hip resulted in a 30 percent
increase in total mortality. (See Chapter 9 for more info on
standard deviations and bone density testing.)

Although we aren’t intending to scare you, we want you to be aware
that hip fractures are serious health problems that can result in
your dying sooner than you would have without a fracture. The
key is to avoid fracturing a hip. How can you stay alive longer by
being fracture free? Prevention, prevention, prevention!

Falling and hip fractures

“Grandma fell and broke her hip.” You’ve undoubtedly heard someone
say this or you’ve even said it yourself. She actually fractured
her femur, probably near the femoral neck.

112 Part III: Diagnosing and Treating Osteoporosis
Some studies show that occasionally people don’t “fall and break
their bone” at all. Instead they have a fracture of the femur from
the simple stress of putting their foot down on a step. So the fracture
causes the fall and not the other way around! How often this
actually happens is difficult to say. Nonetheless, people in the
healthcare field definitely want to prevent as many falls as possible
by changing the environment and preventing hazards.

Some people are more prone to falling than others; they have
what’s known as postural instability. Your co-author Sharon is one
of these people. If you’re one, you undoubtedly already know it.
You may walk into walls and trip over a crack in the sidewalk.

Doctors aren’t quite sure what causes postural instability, but it
may be because you have visual issues, don’t judge spatial relationships
well, can’t decipher depth perception, or have poor contrast
sensitivity.

Whatever your reason for being spatially challenged (or as your
grandchild may say, a klutz), you need to be especially careful
when you have osteoporosis. If you’re a klutz, you know you’re
going to fall or trip sooner or later, and every fall increases your
chance for injury.

The Centers for Disease Control (CDC) statistics indicate that onethird
of all people older than 65 fall each year, and that the majority
of fractures result from falls. The good news is that most falls
occur in your own home.

Why is this good news? It’s good news, because you can control
your own environment. You can’t control the supermarket that
mops aisle one and forgets to put out a “Be Careful” sign, but you
can determine where you place your furniture and the kind of rugs
you have on your stairs. (See Chapter 13 for more on falling and
fractures.) You can also take preventive measures to avoid a fall.
(And make sure to stay off that ladder!)

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