Bone fracture

From Wikipedia, the free encyclopedia

Bone fracture
Classification and external resources

Internal and external views of an arm with a compound fracture, both

before and after surgery.

ICD-10

Sx2 (where x=0-9 depending on the location of the

fracture)

ICD-9

829

DiseasesDB

4939

MedlinePlus

000001

MeSH

D050723

A bone fracture (sometimes abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a break in
the continuity of thebone. A bone fracture can be the result of high force impact or stress, or trivial injury as a
result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer,
or osteogenesis imperfecta, where the fracture is then properly termed apathologic fracture.
Although broken bone and bone break are common colloquialisms for a bone fracture, break is not a
formal orthopedic term.
Contents
[hide]

1 Signs and symptoms

2 Pathophysiology
2.1 Effects of smoking

3 Diagnosis
3.1 Classification

3.1.1 By cause

3.1.2 Orthopedic

3.1.3 Anatomical location

3.1.4 OTA classification

3.1.5 Other systems

4 Treatment

4.1 Pain management

4.2 Immobilization

4.3 Surgery

4.4 Complications
5 In children
6 See also
7 References
8 External links

[edit]Signs

and symptoms

Although bone tissue itself contains no nociceptors, bone fracture is painful for several reasons:[1]

Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both
contain multiple nociceptors.

Edema of nearby soft tissues caused by bleeding of torn periosteal blood vessels evokes pressure
pain.

Muscle spasms trying to hold bone fragments in place

Damage to adjacent structures such as nerves or vessels, spinal cord and nerve roots (for spine fractures), or
cranial contents (for skull fractures) can cause other specific signs and symptoms.

[edit]Pathophysiology
Main article: Bone healing
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a
fracture hematoma. The blood coagulates to form a blood clotsituated between the broken fragments. Within a
few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels
bring phagocytes to the area, which gradually remove the non-viable material. The blood vessels also
bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way the blood
clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a
small amount unless severe or persistent force is applied.
At this stage, some of the fibroblasts begin to lay down bone matrix in the form of collagen monomers. These
monomers spontaneously assemble to form the bone matrix, for which bone crystals (calcium hydroxyapatite)
are deposited in amongst, in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it
and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of
bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-raywithin
6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties
of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole
process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3
months after the injury.
Several factors can help or hinder the bone healing process. For example, any form of nicotine hinders the
process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process.
Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone
strength. Although there are theoretical concerns about NSAIDs slowing the rate of healing, there is not enough
evidence to warrant withholding the use of this type analgesic in simple fractures. [2]

[edit]Effects

of smoking

Smokers generally have lower bone density than non-smokers, so have a much higher risk of fractures. There
is also evidence that smoking delays bone healing. Some research indicates, for example, that it delays tibial
shaft fracture healing from a median healing time of 136 to a median healing time of 269 days. [3] This means
that the fracture healing time was approximately doubled in smokers. Although some other studies show less
extreme effects, it is still shown that smoking delays fracture healing.

[edit]Diagnosis
A bone fracture can be diagnosed clinically based on the history given and the physical examination performed.
Imaging by X-ray is often performed to view the bone suspected of being fractured. In situations where xray alone is insufficient, a computed tomograph (CT scan) or MRI may be performed.

[edit]Classification
[edit]By cause
1. Traumatic fracture - This is a fracture due to sustained trauma. e.g.- Fractures caused by a fall, road
traffic accident, fight etc.
2. Pathological fracture - A fracture through a bone which has been made weak by some underlying
disease is called pathological fracture. e.g.- a fracture through a bone weakened by metastasis.
Osteoporosis is the most common cause of pathological fracture.

[edit]Orthopedic
In orthopedic medicine, fractures are classified in various ways. Historically they are named after the doctor
who first described the fracture conditions. However, there are more systematic classifications in place
currently.
All fractures can be broadly described as:

Closed (simple) fractures: are those in which the skin is intact

Open (compound) fractures: involve wounds that communicate with the fracture, or where
fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher
risk of infection.

Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation
or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently
requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation.

Compression fractures: usually occurs in the vertebrae, for example when the front portion of
a vertebra in the spine collapses due to osteoporosis (a medical condition which causes bones to become
brittle and susceptible to fracture, with or without trauma).

Other types of fracture are:

Complete fracture: A fracture in which bone fragments separate completely.

Incomplete fracture: A fracture in which the bone fragments are still partially joined. In such cases,
there is a crack in the osseous tissue that does not completely traverse the width of the bone. [4]

Linear fracture: A fracture that is parallel to the bone's long axis.

Transverse fracture: A fracture that is at a right angle to the bone's long axis.

Oblique fracture: A fracture that is diagonal to a bone's long axis.

Spiral fracture: A fracture where at least one part of the bone has been twisted.

Comminuted fracture: A fracture in which the bone has broken into a number of pieces.

Impacted fracture: A fracture caused when bone fragments are driven into each other.

Avulsion fracture: A fracture where a fragment of bone is separated from the main mass.

[edit]Anatomical location
An anatomical classification may begin with specifying the involved body part, such as the head or arm,
followed with more specific localization. Fractures that have additional definition criteria than merely localization
can often be classified as subtypes of fractures that merely are, such as a Holstein-Lewis fracture being a
subtype of a humerus fracture. However, most typical examples in an orthopedic classification given in previous
section cannot appropriately be classified into any specific part of an anatomical classification, as they may
apply to multiple anatomical fracture sites.

Skull fracture

Basilar skull fracture

Blowout fracture - a fracture of the walls or floor of the orbit

Mandibular fracture

Nasal fracture

Le Fort fracture of skull - facial fractures involving the maxillary bone and surrounding
structures in a usually bilateral and either horizontal, pyramidal or transverse way.

Spinal fracture

Cervical fracture

Fracture of C1, including Jefferson fracture

Fracture of C2, including Hangman's fracture

Flexion teardrop fracture - a fracture of the anteroinferior aspect of a cervical

vertebral

Clay-shoveler fracture - fracture through the spinous process of a vertebra occurring

at any of the lower cervical or upper thoracic vertebrae

Burst fracture - in which a vertebra breaks from a high-energy axial load

Compression fracture - a collapse of a vertebra, often in the form of wedge

fractures due to larger compression anteriorly.

Chance fracture - compression injury to the anterior portion of a vertebral body with
concomitant distraction injury to posterior elements

Holdsworth fracture - an unstable fracture dislocation of the thoracolumbar junction of

the spine

Rib fracture

Sternal fracture

Shoulder fracture

Clavicle fracture

Scapular fracture

Arm fracture

Humerus fracture (fracture of upper arm)

Supracondylar fracture

Holstein-Lewis fracture - a fracture of the distal third of the humerus resulting

in entrapment of the radial nerve.

Forearm fracture

Ulnar fracture

Monteggia fracture - a fracture of the proximal third of the ulna with the
dislocation of the head of the radius

Hume fracture - a fracture of the olecranon with an

associated anterior dislocation of the radial head

Radius fracture

Essex-Lopresti fracture - a fracture of the radial head with concomitant

dislocation of the distal radio-ulnar joint with disruption of the interosseous membrane.[5]

Distal radius fracture

Galeazzi fracture - a fracture of the radius with dislocation of

the distal radioulnar joint

Colles' fracture - a distal fracture of the radius with dorsal (posterior)

displacement of the wrist and hand

Smith's fracture - a distal fracture of the radius with volar (ventral)

displacement of the wrist and hand

Barton's fracture - an intra-articular fracture of the distal radius with

dislocation of the radiocarpal joint.

Hand fracture

Scaphoid fracture

Rolando fracture - a comminuted intra-articular fracture through the base of the

firstmetacarpal bone

Bennett's fracture - a fracture of the base of the first metacarpal bone which extends into
the carpometacarpal (CMC) joint.[6]

Boxer's fracture - a fracture at the neck of a metacarpal

Pelvic fracture

Fracture of the hip bone

Duverney fracture - an isolated pelvic fracture involving only the iliac wing.

Femoral fracture

Hip fracture (anatomically a fracture of the femur bone and not the hip bone)

Patella fracture

Crus fracture

Tibia fracture

Bumper fracture - a fracture of the lateral tibial plateau caused by a

forced valgus applied to the knee

Segond fracture - an avulsion fracture of the lateral tibial condyle

Gosselin fracture - a fractures of the tibial plafond into anterior and posterior
fragments[7]

Toddler's fracture - an undisplaced and spiral fracture of the distal third to distal half of
the tibia[8]

Fibular fracture

Maisonneuve fracture - a spiral fracture of the proximal third of the fibula associated
with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.

Le Fort fracture of ankle - a vertical fracture of the antero-medial part of

the distal fibula with avulsion of the anterior tibiofibular ligament.[9]

Bosworth fracture - a fracture with an associated fixed posterior dislocation of the

proximal fibular fragment which becomes trapped behind the posterior tibial tubercle. The injury is
caused by severe external rotation of the ankle.[10]

Combined tibia and fibula fracture

Trimalleolar fracture - involving the lateral malleolus, medial malleolus and the distal
posterior aspect of the tibia

Bimalleolar fracture - involving the lateral malleolus and the medial malleolus.

Pott's fracture

Foot fracture

Lisfranc fracture - in which one or all of the metatarsals are displaced from the tarsus[11]

Jones fracture - a fracture of the fifth metatarsal

March fracture - a fracture of the distal third of one of the metatarsals occurring because of
recurrent stress

Calcaneal fracture

[edit]OTA classification
The Orthopaedic Trauma Association, an association for orthopaedic surgeons, adopted and then extended the
classification of Mller and the AO foundation[12] ("The Comprehensive Classification of the Long Bones") an
elaborate classification system to describe the injury accurately and guide treatment.[13][14] There are five parts
to the code:

Bone: The OTA classification of a fracture starts by coding for the bone involved:

(1) Humerus fracture, (2) Radius fracture/Ulnar fracture, (3) Femoral fracture, (4) Tibial fracture/Fibular fracture,
(5) Spinal fracture, (6) Pelvic fracture, (24) Carpal fracture, (25)Metacarpal fracture, (26) Phalanx fracture of the

hand, (72) Talus fracture, (73) Calcaneus fracture, (74) Navicular fracture, (75) Cuneiform bone fracture,
(76) Cuboid bone fracture, (80) LisFranc fracture, (81) Metatarsal fracture, (82) Phalanx fracture of the foot,
(45) Patella fracture, (06) Clavicular fracture, (09) Scapular fracture

Location: a code for the part of the bone involved (e.g. shaft of the
femur): proximal=1, diaphyseal=2, distal=3 (at the ankle the malleolar region is considered separately due
to the pre-existing Weber classification and coded as 4[15]). Except at the proximal femur the distal and
proximal regions of the bone are defined by a square that is as wide as the as the distance between
the condyles. The diaphysis is considered to be the rest of the bone between these two squares.

Type: It is important to note whether the fracture is simple or multifragmentary and whether it is closed
or open: A=simple fracture, B=wedge fracture, C=complex fracture

Group: The geometry of the fracture is also described by terms such as transverse, oblique, spiral, or
segmental.

Subgroup: Other features of the fracture are described in terms of displacement (versus apposition,
which is the degree at which the parts are in contact with each other), rotation, angulation and shortening.
A stable fracture is one which is likely to stay in a good (functional) position while it heals; an unstable one
is likely to get displaced, rotated, angulated or shortened before healing and lead to poor function in the
long term.

[edit]Other systems
There are other systems used to classify different types of bone fractures:

"Denis classification" for spinal fractures[16]

"Frykman classification" for forearm fractures (fractures of radius and ulna)

"Gustilo open fracture classification"[17]

"Letournel and Judet Classification" for Acetabular fractures[18]

"Neer classification" for humerus fractures[19][20]

"Seinsheimer's Classification" for femoral fractures[21]

[edit]Treatment

X-ray showing the proximal portion of a fractured tibia with an intramedullary nail.

Proximal femur nail with locking and stabilisation screws for treatment of femur fractures of left thigh.

Treatment of bone fractures are broadly classified as surgical or conservative, the latter basically referring to
any non-surgical procedure, such as pain management, immobilization or other non-surgical stabilization. A
similar classification is open versus closed treatment, in which open treatment refers to any treatment in which
the fracture site is surgically opened, regardless of whether the fracture itself is anopen or closed fracture.

[edit]Pain

management

In arm fractures in children, ibuprofen has been found to be equally effective as the combination
of acetaminophen and codeine.[22]

[edit]Immobilization
Since bone healing is a natural process which will most often occur, fracture treatment aims to ensure the best
possible function of the injured part after healing. Bone fractures are typically treated by restoring the fractured
pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals.
Often, aligning the bone, called reduction, in good position and verifying the improved alignment with an X-ray
is all that is needed. This process is extremely painful without anesthesia, about as painful as breaking the
bone itself. To this end, a fractured limb is usually immobilized with a plaster or fiberglass cast or splint which
holds the bones in position and immobilizes the joints above and below the fracture. When the initial postfracture edema or swelling goes down, the fracture may be placed in a removable brace or orthosis. If being
treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more
directly. Alternatively, fractured bones may be treated by the Ilizarov method which is a form of external fixator.
Occasionally smaller bones, such as phalanges of the toes and fingers, may be treated without the cast,
by buddy wrapping them, which serves a similar function to making a cast. By allowing only limited movement,
fixation helps preserve anatomical alignment while enabling callus formation, towards the target of achieving
union.
Splinting results in the same outcome as casting in children who have a distal radius fracture with little shifting.
[23]

[edit]Surgery
Surgical methods of treating fractures have their own risks and benefits, but usually surgery is done only if
conservative treatment has failed, is very likely to fail, or likely to result in a poor functional outcome. With some
fractures such as hip fractures (usually caused byosteoporosis), surgery is offered routinely because nonoperative treatment results in prolonged immobilisation, which commonly results in complications including
chest infections, pressure sores, deconditioning, deep vein thrombosis (DVT) and pulmonary embolism, which

are more dangerous than surgery. When a joint surface is damaged by a fracture, surgery is also commonly
recommended to make an accurate anatomical reduction and restore the smoothness of the joint.
Infection is especially dangerous in bones, due to the recrudescent nature of bone infections. Bone tissue is
predominantly extracellular matrix, rather than living cells, and the few blood vessels needed to support this low
metabolism are only able to bring a limited number ofimmune cells to an injury to fight infection. For this
reason, open fractures and osteotomies call for very careful antiseptic procedures andprophylactic antibiotics.
Occasionally bone grafting is used to treat a fracture.
Sometimes bones are reinforced with metal. These implants must be designed and installed with care. Stress
shielding occurs when plates or screws carry too large of a portion of the bone's load, causing atrophy. This
problem is reduced, but not eliminated, by the use of low-modulus materials, including titanium and its alloys.
The heat generated by the friction of installing hardware can easily accumulate and damage bone tissue,
reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i.e., a
titanium plate with cobalt-chromium alloy or stainless steel screws), galvanic corrosion will result. The
metal ionsproduced can damage the bone locally and may cause systemic effects as well.
Electrical bone growth stimulation or osteostimulation has been attempted to speed or improve bone healing.
Results however do not support its effectiveness.[24]

[edit]Complications

An old fracture with nonunion of the fracture fragments.

Some fractures can lead to serious complications including a condition known as compartment syndrome. If not
treated, compartment syndrome can result in amputation of the affected limb. Other complications may include

non-union, where the fractured bone fails to heal or mal-union, where the fractured bone heals in a deformed
manner.
Complications of fractures can be classified into three broad groups depending upon their time of occurrence.
These are as follows 1. Immediate complications - occurs at the time of the fracture.
2. Early complications - occurring in the initial few days after the fracture.
3. Late complications - occurring a long time after the fracture.

Immediate complications

Early complications

Late complications

Systemic

Hypovolaemic shock

ARDS - Adult respiratory distress

syndrome

Imperfect union of the

fracture

Fat embolism syndrome

Delayed union

Deep vein thrombosis

Non union

Pulmonary syndrome

Mal union

Aseptic traumatic fever

Cross union

Septicemia (in open fracture )

Crush syndrome

Systemic

Hypovolaemic shock

Local

Local

Others

Injury to major vessels

Infection

Avascular necrosis

Injury to muscles and

Compartment syndrome

Shortening

tendons

Joint stiffness

Sudeck's dystrophy

Injury to joints

Osteomyelitis

Injury to viscera

Ischaemic contracture

Myositis ossificans

Osteoarthritis

[edit]In

children

Main article: Child bone fracture

In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick
fracture.

A greenstick fracture occurs due to mechanical failure on the tension side. That is, since the bone is
not as brittle as it would be in an adult, it does not completely fracture, but rather exhibits bowing without
complete disruption of the bone's cortex in the surface opposite the applied force.

Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to
make sure that the bone continues to grow normally.

Plastic deformation of the bone, in which the bone permanently bends but does not break, is also
possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed
and cannot be realigned by closed methods.

Certain fractures are known to occur mainly in the pediatric age group, such as fracture of
the clavicle & supracondylar fracture of the humerus.

(Wikipedia.com)

What are fractures?

A fracture is a broken bone. Fractures can range in severity from a crack (known as a hairline or
greenstick fracture), to a complete break and separation of a bone that may protrude through your
skin (known as an open or compound fracture).
Bone Problems Spotlight

Fractures? Join the Discussion

Fractures can occur in any bone in the body, but the most common fractures are of bones in the
extremities and of the ribs. Fractures are most common in young adults who are adventurous in
nature, and in the older population as bones become fragile.
A closed fracture is one in which the bones do not break the skin, while in an open (also known
as compound) fracture, one or more bone fragments protrudes through the skin. Open fractures
are more difficult to treat and have a greater risk of infection. Stress fractures are tiny cracks that
develop in bone due to repeated force, such as overuse injuries.
Some fractures are mild and require little treatment other than pain relievers, icing, and time to
heal. Other fractures, however, can be very serious and can put important nearby tissue, such as
the spinal cord, large vessels, or the brain, at risk.

Seek immediate medical care (call 911) for serious symptoms associated with a fracture
including loss of consciousness, difficulty breathing, a bone that has broken through the skin, or
any suspected fracture of the neck, back, or skull.
Seek prompt medical care if you have a fracture without the serious symptoms above, such as a
broken arm or hand.
What are the symptoms of fractures?

Symptoms of fractures commonly include pain, swelling, bruising, and a change of shape at the
surface of the skin due to the protrusion of a bone in the affected region. More rarely, a fracture
can break through your skin, resulting in bone protruding from a wound.
Common symptoms of fractures

You may experience fracture symptoms immediately after an injury, while sometimes it may take
more time for symptoms to appear. Common symptoms of a fracture include:

Bleeding

Deformity

Inability to move a joint

Numbness and tingling in the affected region

Pain

Redness and warmth

Swelling

Serious symptoms that might indicate a life-threatening condition

In some cases, fractures can be life threatening. Seek immediate medical care (call 911) if you,
or someone you are with, have any of these life-threatening symptoms:

Bone protruding through the skin

Confusion or loss of consciousness for even a brief moment

Profuse bleeding

Suspected fracture of the neck, back, skull, pelvis, hips or femur

Vision changes or loss

What causes fractures?

Your bones are some of the strongest tissues in your body. If an impact or a force is stronger than
the strength of the bone on which it is acting, then a fracture may result. The most common
causes of fracture are falls, motor vehicle accidents, and a weakening of the bone called
osteoporosis.
What are the risk factors for fractures?

A number of factors increase the risk of developing fractures. Not all people with risk factors
will get fractures. Risk factors for fractures include:

Advanced age

Certain genetic disorders

Excessive tobacco or alcohol consumption

Female gender

Lack of physical activity on a regular basis

Lack of proper nutrition, especially calcium

Osteoporosis (thinning and weakening of the bones)

Participation in sports

Thyroid or endocrine disorders

Vitamin deficiencies

Reducing your risk of fractures

There are a number of ways you can reduce your risk of a fracture, though it is impossible to
completely eliminate any chance of a fracture.
You may be able to lower your risk of fracture by:

Following your treatment plan for treatment or prevention of osteoporosis

(which may involve calcium and vitamin D supplementation and medications)

Living a healthy lifestyle with a good diet and lots of physical activity

Watching young children closely

Wearing a seatbelt any time you are in a car

Wearing protective equipment when participating in sports

How are fractures treated?

Fractures are treated in a variety of ways. The intention of most treatments is to realign the
fractured bones in their original orientation and then to eliminate movement so the bones can
heal. Realignment of the bone pieces in a fracture is known as reduction of the fracture.
Treatment can vary from using ice and pain relievers (for a mild broken nose) to immediate
emergency surgery.
Because an untreated fracture can have serious complications, it is important to always discuss a
suspected fracture with your health care provider, even if the fracture seems mild.
Nonsurgical treatment of fractures

Many fractures can be treated without surgery. Treatment for these fractures includes casts or
splints that can be applied around a fractured limb after the fracture is reduced to limit movement
and encourage healing. Casts are very commonly used for mild or moderately severe fractures of
the extremities. Once in place, a cast is usually left on for several weeks.
Surgical treatment of fractures

Many fractures require surgery to repair. Though surgery comes with its own risks, modern
orthopedic techniques can lead to improved outcomes. The surgical technique used will depend
on the nature of the specific fracture. Some of these techniques include:

Metal plates may be screwed onto your broken bone to prevent it from
moving and to promote healing

Metal rod may be placed inside the center of a long bone to help reattach two
ends of a fracture and to maintain alignment. This technique is called
intramedullary fixation.

Pins and rods may be placed in your bones and continue outside your skin,
where they can be attached to a metal cage. This technique is known as
external fixation and allows for slight adjustments to be made to the
orientation and position of a bone as it heals.

What you can do to improve your fracture

Your health care provider almost always must treat a fracture. The way you treat a fracture
immediately after it happens and before you can get to a hospital is important. You can improve
the outcome of your fracture by following these rules:

Apply ice to a fracture to reduce swelling

Prevent any movement of a victim if a head, neck, or back fracture is

suspected

Try to immobilize the broken bone if a person must be moved or carried to

safety

What are the potential complications of fractures?

Fractures can range from mild to severe and can result in almost no complications or can result
in serious complications. The cause of the fracture, the location of the fracture, and the way the
fracture is treated will all affect the potential complications.
You can help minimize your risk of serious complications by following the treatment plan you
and your health care professional design specifically for you. Complications of fractures include:

Infection that can be local or can spread systemically

Loss of a limb

Osteomyelitis (bone infection)

Paralysis resulting from a neck or back fracture

Permanent deformity

Permanent loss of sensation

References:
Broken bone. Medline Plus, a service of the National Library of Medicine National Institutes of
Health. http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm. Accessed May 16, 2011.
Thighbone (femur) fracture. AAOS: American Academy of Orthopaedic Surgeons.
http://orthoinfo.aaos.org/topic.cfm?topic=a00364. Accessed May 16, 2011.
(http://www.localhealth.com/article/fractures-1/treatments)

Fracture Prevention: 6 Tips to Fight Fractures, Slips, and Falls

Learn how just a little effort and forethought today can help you prevent fractures
tomorrow.
By R. Morgan Griffin
WebMD Feature
Reviewed by Louise Chang, MD

If you have osteoporosis, treating the condition directly -- with medicines or calcium
supplements -- is obviously important. But it's also crucial to do everything you can to avoid the
most serious risk of osteoporosis: broken bones. Practicing fracture prevention is a vital part of
your osteoporosis treatment.
According to the National Institutes of Health, osteoporosis causes 1.5 million bone fractures
every year. And these broken bones can be a lot more than painful and inconvenient. They can
have a devastating and sometimes permanent impact on your health.
Recommended Related to Osteoporosis

Weight-Bearing Exercise: 8 Workouts for Strong Bones

What are the best ways to exercise and improve your bone health when you have osteoporosis?
Try weight-bearing workouts that stress bones and muscles more than your everyday life, says
Paul Mystkowski, MD, an endocrinologist at Virginia Mason Medical Center in Seattle and
clinical faculty member of the University of Washington in Seattle. Talk to your doctor and make
sure the workout you choose is safe for you. Then give these latest trends a try! 1. Tai Chi Tai chi
-- a form of slow,...
Read the Weight-Bearing Exercise: 8 Workouts for Strong Bones article > >

So what can you do to avoid broken bones and painful rehab? Here's a list of six tips for fracture
prevention that every person with osteoporosis should know. By asking your doctor the right
questions -- and making a few changes to your habits -- you can greatly reduce your risks.
The Importance of Fracture Prevention

In people with osteoporosis, fractures can happen anywhere, but wrist fractures, hip fractures,
and spinal fractures are the most common. The effects can be serious. 700,000 people with
osteoporosis fracture their vertebrae every year, and many are left with chronic pain. Of the
300,000 people with osteoporosis who have a hip fracture this year, half will never be able to
walk again without assistance. And a staggering 20% of people over age 50 who break a hip will
die within a year from complications.
If you're older and have osteoporosis, not only are falls much more dangerous, but they're more
likely too. As you age, your body's muscle tone decreases. Your vision worsens. You're more
likely to need medications, which can affect your balance. Even seemingly trivial things, like
needing to go to the bathroom more in the night, can up your odds of falling. Essentially, a
number of minor risks associated with aging coalesce at the same time, greatly increasing the
possibility of a fall and fractured bone.
The good news is that with some simple changes to your lifestyle, you can seriously lower these
risks. Here's a rundown of what you can do.
Fracture Prevention Tip: Exercise to Improve Balance and Strength

Many people with osteoporosis worry about the risks of exercise. After all, if you're jogging on a
treadmill or out hiking, aren't you at higher risk of falling? What could better protect you from a
broken bone than sitting in a comfy armchair all day?
Although the argument makes intuitive sense, it's actually backward. The fact is that exercising
reduces your risk of falls.
"Keeping physically active helps your reflexes stay sharp and your muscles stay strong," says
Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minnesota. "That can
help with coordination and lower your risk of falling." If you're fit, your balance is better, and
that makes you much less likely to take a fall than someone who has become bedridden and
infirm. Aside from improving your balance and strength, exercise also has a direct impact on the
strength of your bones. Bone is a living tissue. Like muscle, it weakens if you don't exercise it.
By staying fit, you can make your bones stronger and less likely to break during a fall. Experts
generally recommend a combination of weight-bearing exercise (like walking), resistance
exercise (like lifting weights), and flexibility and balance exercises (like yoga or tai chi).

However, a note of caution: always talk to your doctor before starting up an exercise routine.
High impact exercise, like jogging or tennis, may not be safe for some people with osteoporosis,
since the physical pounding could cause a fracture. Even some seemingly benign exercises, like
crunches, can be risky for people with weak vertebrae, Amin tells WebMD.

Fracture Prevention Tip: Tread Carefully

If you have osteoporosis, you need to consider more than fashion when choosing your shoes.
Wearing the wrong sort of footwear can really increase your risk of a fall.
But happily, you don't have to be stuck with "sensible shoes" either. Just look for low-heeled
shoes that offer good support and have rubber soles rather than leather ones. While sneakers are
fine, avoid ones with deep treads that can trip you up.
Also, it's time to start wearing shoes inside the house too: walking around in socks and slippers
can increase your risk of slipping.
When you're walking outside, play it safe. Walk on the grass when it's been raining or snowing,
since you're more likely to slip on concrete. Always put down salt or kitty litter on icy patches
around your home.
If you have difficulty walking due to a medical condition such as arthritis or another problem,
make sure to use the assistive device recommended by your doctor or physical therapist such as a
cane or walker.

Fracture Prevention Tip: Know How Medicines Might Affect You

Unfortunately, as you get older, you're more likely to need daily medications. And all
medications have side effects, some of which can increase your risk of having a fall. Medications
that can cause dizziness or lack of coordination are:

Sedatives or sleeping pills

Drugs that lower high blood pressure, which can sometimes cause hypotension, blood
pressure that is too low

Antidepressants

Anticonvulsants, which are used to treat epilepsy and some psychological conditions

Muscle relaxants, which may be used for back pain or other problems

Some medicines for heart conditions

Other drugs, like some corticosteroids, are also associated with a higher risk of osteoporosis and
fractures. Just the number of medicines you take can increase the danger. Studies have linked
taking four or more prescription medicines with a higher rate of falls, regardless of what the
drugs are. But given that you need these medicines for other health reasons and can't just stop
taking them, what should you do? Go over all the drugs you take with your doctor. Bring in a list
or the bottles themselves. Keep in mind that one doctor -- like your primary care provider -might not know what other doctors -- like your cardiologist, or rheumatologist -- have
prescribed.
If any of the medicines you take are increasing your risk of falls, see what can be done. It's
possible that your doctor can change your dosage or change medicines altogether so that you're
less likely to take a fall.
And keep in mind that alcohol -- along with illicit drugs -- are also a risk. Anything that impairs
your functioning bumps up your risk of falling.

Fracture Prevention Tip: Lighten Up

As you age, you may notice that your vision isn't quite as keen as it once was. Sometimes this is
due to a treatable health condition, like cataracts. But it's also the result of natural, physiologic
changes that can't be controlled.
"As we get older, we lose some of the contrast sensitivity in our vision," says John Schousboe,
MD, director of the Park Nicollet Clinic Osteoporosis Center in St. Louis Park, MN. "This makes
it harder to discern objects," especially in low light. So you need to brighten up your home. Here
are some tips.

Install overhead lights in all rooms, so you don't have to stumble around in the dark to
find the lamp.

Use nightlights in your bedroom, bathroom and any hallways that connect them.

Make sure all stairways, both inside and outside, are well lit.

Keep a flashlight by your bed.

If you're concerned about the high electric bills that could come with brightening up your home,
consider compact fluorescent bulbs. They work in regular light sockets and offer the same
amount of light as traditional incandescent bulbs, but use much less electricity. They also last
much longer, which reduces the number of times you have to hazard standing on a stepladder to
change a bulb.

Fracture Prevention Tip: "Fall-Proof" Your Home

Given that you probably spend the bulk of time in your home, a key part of fracture prevention is
to make it safer. But this advice is often ignored. "Many people just don't do a very good job fallproofing their homes," says Amin.
So what should you do?

Keep rooms free of clutter -- get rid of those piles of clothes and boxes of papers.

Put down carpet or plastic runners on polished -- and potentially slippery -- floors.

Get throw rugs, electric cords, and phone lines off the floor.

Make sure to have handrails on all stairs.

Install railings in the bathroom around the toilet and the shower.

Put a rubber mat on the floor of your bath or shower.

Fracture Prevention Tip: Treat Health Conditions

Many chronic diseases and health conditions become more common as you get older.
Some can affect your strength or physical functioning and increase the risk of a fall.
Arthritis can make it hard to move around. Obviously, vision problems directly increase
your risk of tripping. Other conditions associated with fractures include chronic lung
disease, hyperthyroidism, cancer, chronic liver disease, chronic kidney disease, and
endometriosis.
If you have any other health conditions, ask your doctor if they might increase your risk
of a fall. If they do, see if any treatments might help. One difficulty is that some of these
problems may come on so gradually that you might not even notice. For instance, you
might not realize that your vision is slowly getting worse, or if your gait has become a
little less steady. That's why it's important to get regular check-ups: not only with your
doctor, but your eye doctor and any other specialists you need.

Bone Fractures Aren't Inevitable

Even with precautions, some types of bone fractures are tough to avoid. Just a mild bump
can be enough to break a bone in people with severe osteoporosis. Only 10-15% of
vertebral fractures are caused by falls, Schousboe says. Many are caused by physical
stress, perhaps by something as simple as bending over or even coughing.
But this just drives home how important prevention is: since some fractures can't be
prevented, you need to work on the fracture risks you can control. While bone fractures
may be more likely as you get older, they aren't inevitable.
Sure, some of these fracture prevention tips require a little effort and forethought on your
part. It's easy to put them off or ignore them. But are they worth it? You bet. Better to
take precautions now than regret not taking them later -- while you lie in a cast counting
the panels in your hospital room ceiling.

(http://www.webmd.com/osteoporosis/features/fractures)