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Orthopedic Considerations in the Older Adult. What to worry about in the old folks!!!. Topics to cover and relate…. Arthritis Osteoporosis disease and prevention Falls and prevention Types of Injuries. The elderly…a increasing concern.
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Orthopedic Considerations in the Older Adult What to worry about in the old folks!!!
Topics to cover and relate….. • Arthritis • Osteoporosis disease and prevention • Falls and prevention • Types of Injuries
The elderly…a increasing concern • Although the big surge in the elderly population is not expected until the baby boomers turn 65 in the next century, significant demographic shifts are already underway. In 1940 only 7 percent of Americans had a chance of living to age 90; in 1980, it was 24 percent. In 1950 there were 4,475 persons age 100 years or older; by 1990, the number was 54,000.
Osteoporosis and the Orthopedic Surgeon • First fracture may be warning sign • Osteoporosis, or "porous bone" is a medical condition that weakens bone by making it more porous and less dense. Bone density is one of the factors that determine bone strength, so individuals with low bone density have a higher risk for fracture and refracture.
Osteoporosis • Disease of adolescence!! • 35 and 50 years old: • You may have begun to gradually lose bone. At this stage in your life, getting enough calcium (1,000 mg each day) and exercise are crucial to keep bone loss to a minimum. Most women enter menopause between the ages of 42 and 55.
OSTEOPOROSIS • You should be getting 1,000 mg of calcium each day. If you rarely get out in the sun, vitamin D also may be recommended • (2 Na free TUMS!) • Try to walk, jog or perform a resistance workout for at least 20 minutes, three times a week.
OSTEOPOROSIS • Over 50 years old: • For women who have gone through menopause, they may be losing bone at a rate of 1 to 6 percent per year • Adequate calcium intake and exercise still are important
Men and Osteoporosis ? • Men should also be concerned about osteoporosis. Approximately one in eight men will have an osteoporotic fracture. Men with a history of hypogonadism, thyroid dysfunction, long-term steroid therapy, high alcohol consumption or low physical activity are especially at risk. One-third of all hip fractures experienced by men are related to osteoporosis, and one-third of these men will die within the first year after the fracture.
Osteoporosis and Fractures • The risk of a serious fracture can double after a first fracture in certain high-risk groups. Additionally, many patients, particularly those who suffer hip fractures, are at high risk for premature death or loss of independence after the fracture.
Osteoporosis and Fractures • One out of four people who have an osteoporotic hip fracture will need long-term nursing home care. • Half of those who experience osteoporotic hip fractures are unable to walk without assistance. • Those who experience the trauma of an osteoporotic hip fracture have a 24% increased risk ofdyingwithin one year following the fracture
Osteoporosis and Fractures • Osteoporosis is a contributing factor in as many as 1.5 million fractures each year, including: • About 300,000 hip fractures • About 700,000 vertebral (spine) fractures • About 250,000 wrist fractures • About 300,000 fractures at other sites
Osteoporosis and Fractures • Hispanic women may be among those at highest risk. Between 13 percent and 16 percent of Hispanic women have osteoporosis. As many as 49% of Mexican-American women 50 years of age or older have low bone density. • Although the rate of hip fractures is lower in Asian-American women, the rate of vertebral fractures is about equal between Asian-American and Caucasian women. • About 10 percent of African-American women over 50 have osteoporosis. An additional 30 percent have low bone density. Between 80 percent and 95 percent of all fractures experienced by African-American women over age 64 are related to osteoporosis.
Osteoporosis and Fractures • . Make sure you get enough calcium and vitamin D in your diet. The National Academy of Sciences recommends 400 to 800 units of Vitamin D and 1,000 to 1,500 mg of Calcium per day. • How many Sodium free TUMS is that??
Osteoporosis • Participate in activities that will strengthen bone and muscle. Regular exercise is one of the best things you can do to prevent osteoporosis. Weight-bearing exercises like walking, jogging and tennis and low-impact exercise classes are best for building and maintaining strong bones.
Osteoporosis • Because falls are the most common cause of fractures, do some balance activities to reduce your risk.
Fall Prevention: • If you have osteoporosis and you fall, you are likely to break a bone. Ten million people currently have osteoporosis; another 34 million have low bone mass and therefore are at risk of developing the disease. More than 1.5 million Americans each year sustain a fracture related to osteoporosis.
Orthopedic Surgery • Hip fractures remain a major source of morbidity and mortality in the elderly, and their incidence is increasing as the population ages. Surgical management followed by early mobilization is the treatment of choice for most patients with hip fractures. However, all co morbid medical conditions, particularly cardiopulmonary and fluid-electrolyte imbalances, must be evaluated and stabilized prior to operative intervention
Hip Fractures • Non displaced femoral-neck fractures should be stabilized with multiple parallel lag screws or pins. The treatment of displaced femoral-neck fractures is based on the patient's age and activity level: young active patients should undergo open reduction and internal fixation; older, less active patients are usually treated with hemiarthroplasty, either uncemented or cemented. Regardless of treatment method, the goal is to return the patient to his or her prefracture level of function.
Hip Fractures: Mortality and Outcomes • Mortality rates in the first year following a broken hip are around 25%, and the rates are highest in older populations. The cause of mortality following a hip fracture is often due to blood clots, pneumonia, or infection. Furthermore, only about 25% of patients who sustain a broken hip return to their pre-injury level of activity.
Hip Fractures: Mortality and Outcomes • Most important factor was the mental acuity of the patient prior to and after the fracture. (hip fractures VA Hospital Study)
Femoral Neck Fractures • Garden Classification • 1-2 Non Displaced • 3-4 Displaced • Disruption of blood flow with resulting avascular necrosis • Internal Fixation vs Arthroplasty
Femoral Neck Fractures: • Difficult to see non displaced fractures • May need bone scan or CT or MRI to diagnose • Low velocity falls • May be diagnosed late • May turn nondisplaced into a displaced fx
Femoral Neck Fractures: Bone scan
Femoral Neck Fx: Protocol • High index of suspicion • Xray ap/lat and cross table lat of femoral neck • Exam is not always helpful • Need further studies MRI CT or bone scan • When in doubt, act like its broken!!!!
Colle’s Fracture (Colles’ fracture?) • Colles Fracture • Most common upper extremity fx in the elderly • Wet leaves, snow, throw rug, tripped over a pet……. • Hyper extension deformation force to the wrist
Comminuted Distal Radius Fracture • Silver fork deformity
CompressionFracturesThoracic and Lumbar Can any of you tell me whether this is Lumbar or Thoracic??
Back and Spine • Back or spine injuries are the most prevalent musculoskeletal impairments • Difficult to diagnose masquerade as cardiac or gastric or pulmonary discomfort in the elderly
Compression Fractures • Burst type • Cord impingement • Usually from activity or a fall • Usually higher velocity injury
Compression Fracture • Wedge pattern • Much more common • Function of osteoporosis an lack of structural support • Look for other causes!!!!! METASTASIS INFECTION
