What is a fracture?
Fracture is defined as a break in the continuity of a bone. Bones are made of two vital elements namely protein and minerals, i.e. calcium and phosphorus.
As age advances, there is a reduction in bone mass. Diseases such as osteomalacia (softening of the bone) or osteoporosis also lead to impaired mineralization of bones.
Due to these reasons, bones of older people are more fragile and hence more vulnerable to fractures.
A fracture which is caused due to extensive trauma in a young patient can be due to a simple fall in an old patient. Since there is a decrease in the metabolic rate of the body as well as healing capacity due to aging, fractures are responsible for increased morbidity and mortality in the older age group.
Types of fractures
- Simple fracture or closed fracture: In this type of fracture the broken bone has not pierced the skin.
- Compound fracture or open fracture: In a compound fracture, parts of broken bone have pierced the skin.
- Hairline fracture: There is an incomplete break or a crack in the bone.
How common is a fracture?
The most common fracture in elderly are fractures of the hip, forearm and the spine. Nearly 75% of hip, spine and forearm fractures occur in people above the age of 65 years.
What are the symptoms of fractures?
The symptoms of a fractured bone depend upon the type of fracture as well as on the bone that has been fractured. For example, hip fractures are more dangerous and debilitating than fractures of the ankle.
The common symptoms which a patient might present are:
- Pain at the site
- Swelling and redness around the area
- Restriction of movement of the affected joint
- Bleeding at the site
- Bruising around the area can also be seen in case of injury
What are the causes of fracture?
Fractures may occur in case of trauma like road traffic accidents, fall from a height, etc.
They usually are a result of poor vision and disbalance. Fractures could also be caused due to diseases like osteoporosis or underlying bone cancer that lead to increased fragility of bones that lead to even minor falls resulting in a fractured bone.
Also Read: Accidents in elderly
Who are at increased risk of fractures?
Women are more prone to fractures than men due to decreased bone mass, smaller size as well as an increased risk of osteoporosis.
Risk factors other than gender are:
- Cigarette smoking
- Alcohol consumption
- Lack of physical activity
- Nutritional deficiency, ex: Deficiency of vitamin D
- Parkinson’s disease
- Alzheimers disease
- Stroke patients
- Patients on certain medications like steroids, sleep medications, etc.
What are the complications of fractures?
Complications of fracture include:
- Improper healing of the fractured bone
- Loss of muscle mass due to restricted movement of the affected joint
- Injury to the underlying organs like an injury to lungs in rib fractures
- Damage to surrounding skin, nerves, etc.
- Infection of the fracture site
Hip fractures which are one of the most common fractures seen in elderly can cause the following additional complications:
- Blood clots
- Urinary tract infection
How to treat a fracture?
1. Investigation: The primary investigation for any fracture is the X-ray examination. X-rays will show the site of fracture as well as its severity. Other investigations include:
- Artery Doppler
- Neurological examination
2. Treating the fractures: Treatment depends on site and severity. The treatment can be a simple plaster cast to immobilize the bone or surgical treatment which uses screws, plates, etc. to join the bone fragments. Hip fractures usually require surgical treatment.
The patient is then prescribed with calcium supplements, pain medications and antibiotics to prevent infection of the fracture site. Once the cast has been removed or in case of surgeries, the doctor has given a go ahead, the rehabilitation therapy starts.
3. Rehabilitation therapy: The main objective of rehabilitation therapy is to restore the movement in the affected part. It constitutes various exercises and physiotherapy on a routine basis which the patient has to undergo. It takes time to fully recover from a fracture and gain full function of the affected part. It is important for the patient to stay motivated and continue the exercises and prescribed treatment.
What are the lifestyle changes can help in preventing fractures?
Lifestyle changes mainly involve reducing or eliminating the risk factors which include:
- Regular physical exercises
- Improving balance i.e. various exercises are helpful in improving balance as well a stick or a cane can be used while walking.
- Quit smoking
- Avoid alcohol
- Nutritious diet rich in calcium and vitamin D
- Routine checkup of blood pressure
- Periodic review of medication prescribed by doctor
- Avoid slippery floors
- Repairing the area which could potentially lead to slipping or falling
How to take care of someone with a fracture?
There are 2 stages of taking care of someone suffering from fracture:
- During Fracture: If a fracture is suspected then measures that can be taken at home before rushing to the doctor include:
- Apply pressure to control any bleeding at the site
- Ask the patient to not move the affected joint
- Give cold compresses in case of swelling
- Do not try to straighten or realign the bones. It can cause more damage.
- Ask the patient to rest
- Don’t feed anything to the patient in case a surgery may be needed
- Post fracture care:
- Ensure that the patient gets proper rest
- The patient should be given a nutritious diet especially rich in calcium and vitamin D.
- An attendant or a family member should assist the patient in their routine tasks like sitting, standing, going to the bathroom, bathing, etc.
- In case of a plaster cast ensure that the cast doesn’t get wet
- Consultation with the doctor- If there is any redness, bluish discoloration around the area, or the patient has a fever, doctor should be consulted without any delay
It is important for the patient to have a strong support system since fracture takes a long time to recover. In fractures where the patient is bedridden, routine tasks become a great problem which can cause psychological stress. Psychological support, as well as motivation, is important to help the patient continue their medication as well as the physical exercises prescribed.