What are Geriatric Fractures?
A fracture is defined as a break in the continuity of the bone when a force against your body is too strong for the bone to bear. Geriatric fractures refer to a broken bone in older adults or individuals over 65 years of age. This geriatric age group has both an increased predisposition to injury and an increased rate of trauma from even minimal force. This makes older adults a high-risk population for traumatic fractures from low- or high-impact injury. Lower trunk fractures involving the hip, pelvic and lower spine were found to be the most common geriatric fractures followed by upper trunk fractures involving the upper spine, clavicle, and ribs.
Causes of Geriatric Fractures
Most fractures in older adults occur as a result of a combination of weak bones (such as from osteoporosis) and a fall. As you grow older, your bones become weaker from natural changes in bone tissue. In postmenopausal women, bone weakening is much greater due to a decline in the level of the female hormone estrogen. When bones become frail and brittle, even common activities such as bending forward, lifting something, or stepping down harder can be enough to cause a fracture. Some of the common causes of geriatric fractures include :
- Fall from a height
- Low energy trauma, such as fall from tripping or slipping
- High-energy trauma, such as motor vehicle collisions
- Fracture from twisting forces
- Sporting injuries
Risk Factors for Geriatric Fractures
Simply growing older increases your susceptibility to fracture. But your risk of fracture and bone loss with aging increases even more if you have any of the following conditions :
- Osteopenia or osteoporosis (loss of bone mass)
- Other bone conditions such as rheumatoid arthritis, Paget’s disease, or cancer
- Caucasian race
- Female gender
- Genetic predisposition
- Sedentary (inactive) lifestyle
- Thyroid disease
- Vitamin D deficiency
- History of prior fracture
- Long-term tobacco or alcohol abuse
- Long-term use of certain medications
Signs and Symptoms of Geriatric Fractures
Some of the signs and symptoms of geriatric fractures include :
- Severe pain
- Inability to bear weight
- Instability
- Difficulty moving the injured area or nearby joints
- Bone deformity
- Swelling/bruising
- Numbness or tingling
Diagnosis of Geriatric Fractures
To diagnose geriatric fractures, your doctor will review your symptoms and medical history and conduct a thorough physical examination to look for signs of swelling, bruises, rupture of the skin, or other deformities. Additionally, in order to obtain further information on the condition of the soft tissue around the fracture, type, and severity of the fracture, and confirm the diagnosis, your doctor may recommend :
- X-rays : This study uses high electromagnetic energy beams to produce images of the bones and helps to detect whether the bone is intact or broken and the type of fracture and its location.
- CT scan : This scan uses special x-rays that produce images of the cross-section of your limb with clear images of any damage present that is not visible in an x-ray. It provides your doctor with crucial information about the severity of the fracture.
- MRI Scan : This study produces images that help in detecting damage to soft tissues or ligaments using large magnetic fields and radio waves.
- Bone scan : This is a nuclear imaging study that helps your doctor to detect hidden stress fractures or any bone disorders such as arthritis, bone infection, or Paget’s disease of the bone.
Treatment for Geriatric Fractures
The main objective of the treatment is to put the fragments of bone back in place, manage the pain, provide time for the bone to heal, avert complications, and restore normal function of the fractured area. The most common fractures in the geriatric age group are vertebral fractures from trauma or compression, followed by hip and distal radius fractures.
Treatments may include both non-surgical and surgical methods.
Nonsurgical Treatment
- Casting : In this method, a spica cast is used to hold the fractured bone fragments in proper position and alignment until the bone heals. A cast is a covering made of plastic or fiber that encases the affected limb to stabilize the bone.
- Traction : Traction refers to the utilization of a steady pulling mechanism to stretch certain segments of the body in a particular direction. Traction commonly utilizes weights, strings, pulleys, and a metal frame attached on or over the bed. The goal of traction is to stretch the muscles and tendons around the broken bone to assist the bone ends to align and heal.
- Medications : This involves the use of pain-relievers and anti-inflammatory medications, such as naproxen and ibuprofen to control pain and inflammation.
Surgical Treatment
- External fixation : This method is performed in case you have multiple injuries. Your doctor will place metal screws and pins inside the bone which will be attached to a rod present outside the skin. This helps to hold the bones in the correct position while they heal.
- Intramedullary nailing : In this method, a rod is passed along the broken bone and intramedullary nails made of titanium are fixed above and below the bone to stabilize and heal it.
- Plates and screws : In this procedure, your doctor will reposition the fragmented bones and align them by fixing them with screws and metal plates. The plates and screws method is employed when intramedullary nailing is not a viable option.
- Balloon kyphoplasty or vertebroplasty : These are minimally invasive procedures employed for the treatment of vertebral compression fractures, a type of spinal fracture that usually occurs due to weakness of the bone from osteoporosis. The fracture occurs in the vertebral body, a cylindrical block of bone towards the front of each vertebra. The vertebral bodies help support the spine but can develop fractures with everyday activities such as lifting if they become weak.
- Vertebroplasty : Using live X-ray imaging, your doctor will insert a large needle through the skin into the fractured vertebra and inject bone cement into it. The needle is then withdrawn before the cement hardens. The cement quickly hardens and provides strength and stability to the vertebra.
- Balloon kyphoplasty : This is similar to vertebroplasty and involves the introduction of balloons into the fractured vertebra which are inflated to restore normal vertebral height. The vertebral bone is then stabilized with the injection of bone cement.
After the surgery, your doctor will recommend physical therapy to strengthen the bone and surrounding muscles and to help ensure return to optimum function as quickly as possible.
Prevention of Geriatric Fractures
Most geriatric fractures occur as a result of accidental falls, injuries, or body movements such as bending forward to lift weights, which cannot always be avoided. However, there are certain healthy lifestyle practices that one can incorporate to decrease the risk of bone fractures, including :
- Consuming lots of vegetables and a diet rich in vitamin D and calcium to strengthen bones
- Following regular strength training and weight-bearing exercises to help keep bones strong
- Refraining from tobacco and nicotine products, which can increase your risk of bone fractures and impede the healing process
- Maintaining a healthy and stable weight
- Regular follow-ups with your physician to keep track of your vitamin D and calcium levels and your bone health
