Article

Evaluation and treatment of osetoporotic distal radius fracture in the elderly patient

Department of Orthopedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA.
Current Reviews in Musculoskeletal Medicine 01/2013; 6(1). DOI: 10.1007/s12178-012-9153-8
Source: PubMed

ABSTRACT

Distal radius fractures are an increasingly prevalent upper extremity injury, especially among elderly patients. While treatment guidelines for the acute bony injury have been well documented, treatment of the underlying metabolic bone disease has been less commonly discussed in the orthopedic literature. Distal radius fractures in the elderly patient should be considered a sentinel event for injuries associated with greater morbidity and mortality, such as hip fracture. Management of fracture-related factors, such as osteoporosis and increased fall risk following a distal radius fracture, may prevent the mortality and morbidity of future injuries. This review highlights both the fracture-specific and medical goals of treatment in the elderly patient with a distal radius fracture.

Download full-text

Full-text

Available from: Daniel A Osei, Jun 16, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Distal radius fractures are costly and debilitating injuries, especially for the elderly. These fractures often occur from falls and commonly occur outdoors. Inclement weather may increase the risk of fall-related injuries. Small studies have reported an increased risk of distal radius fracture caused by inclement winter weather; larger studies are lacking. The authors analyzed a sample of 2007 Medicare claims for distal radius fracture. Weather data were collected for the date and location of each distal radius fracture in the authors' analysis cohort. A novel slipperiness score was used as a measure of the severity of slippery outdoor conditions. Negative binomial regression models evaluated the correlation between slipperiness and distal radius fracture occurrence. Risk of distal radius fracture was higher in winter months (incidence rate ratio, 1.2; p < 0.001). Days with average temperature less than or equal to 32°F (incidence rate ratio, 1.36; p < 0.001), snow/ice on the ground at the start of the day (incidence rate ratio, 1.45; p < 0.001), and freezing rain (incidence rate ratio, 1.24; p = 0.025) all had an increased risk of distal radius fracture. The risk of sustaining a distal radius fracture was increased 21 percent on days with a slipperiness score above 4 (incidence rate ratio, 1.21; p = 0.007). For each increase in slipperiness score above 4, the incidence rate ratio of distal radius fracture increased as well. Weather events that create slippery walking conditions, often in the winter, result in an increased risk of distal radius fracture in the elderly. This finding can be used to support resource allocation and awareness and prevention campaigns. Risk, IV.
    Full-text · Article · Feb 2014 · Plastic and Reconstructive Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Distal radius fractures are the most common fracture involving the upper extremity. Despite their frequency, there is a lack of consensus within the orthopedic community regarding indications for operative management of these injuries in the elderly population. An increase in the rate of operative fixation has been cited in the past decade, however, there is no definitive evidence in the literature to support such a trend. Although studies have reported successful functional outcomes with both operative and nonoperative management, the current evidence regarding indications for operative management remains inconclusive due to a lack of large-scale, prospective, randomized trials in the elderly population. Until evidence-based algorithms can be established, treatment decisions must be made based on clinical judgment and risk assessment, while taking into account the functional demands of each patient.
    No preview · Article · Jun 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: This study aimed to document clinical use of Traditional Chinese Medicine (TCM) for chronic conditions in all TCM hospitals in a Chinese province and to recommend treatments most in need of evaluation for use in community health centers. Design: A cross-sectional survey was conducted in the summer of 2010. It included 119 of 132 TCM hospitals in Hubei Province, China. TCM physicians were asked to recommend specific TCM treatments for common chronic conditions. Nine types of chronic conditions recommended more than 3.7 times (mean of frequencies of chronic conditions) are included in this analysis. Frequency of each TCM treatment and the number of visits by type of chronic conditions were calculated. Results: The total number of recommendations by TCM physicians was 411. For seven types of treatments, six were recommended for musculoskeletal pain, five for soft tissue injuries, four for visceral pain and fractures, three for stroke and asthma, two for hemorrhoids, and one for hypertension. The most frequently recommended treatments for specific conditions include orally ingested herbs for visceral pain (n=3), type 2 diabetes (n=5), and hypertension (n=7); herbs for external use for soft tissue injuries (n=10), asthma (n=6), and hemorrhoids (n=8); acupuncture for musculoskeletal pains (n=43) and for stroke (n=10); and Chinese external fixation for fractures (n=24). The number of visits for recommended treatments per year of was 671,759. The most frequently recommended treatments for specific chronic conditions have most visits, except for chronic conditions such as musculoskeletal pains, visceral pains, soft tissue injuries, and asthma. Conclusions: Patients with musculoskeletal pain have more treatment options than other patients. Herbal medicine is the option most commonly used for chronic conditions. These treatments for these conditions should be targeted for further evaluation of effectiveness and, only if found effective, considered for use in primary care settings.
    Full-text · Article · Dec 2014 · Journal of alternative and complementary medicine (New York, N.Y.)
Show more