The term geriatric refers to the medical treatment given to an elderly individual (usually over the age of 65 years). Fractures in the elderly are a common occurrence and often require only the most trivial of injuries to result in a bone break, often debilitating in nature. At Sri Balaji Hospital, we offer professional treatment for geriatric fractures, ensuring specialised care for the unique needs of elderly patients.
The most typical cause for fractures in older people is usually a result of falls at their residence caused by slipping or tripping on rugs, carpet mats, etc. Fractures in the elderly could, of course, be a result of a high-velocity injury such as a road traffic accident as well. The risk of these falls increases exponentially in elderly individuals with dementia and other causes for diminished cognitive functions. The commonest types of fractures that are witnessed among individuals in the elderly age group include (but not limited to):
These fractures usually occur close to the hip joint (the ball and socket joint). These fractures most commonly affect the upper part of the thigh bone (inter-trochanteric fractures) nearer to the ball of the ball & socket joint (neck of femur fracture). A rarer form of hip fracture involves a crack or fracture to the socket (acetabulum) of the ball and socket joint.
These fractures involve the breaking of the upper part of the thigh bone (femur).
Cause of injuries:
Slip & fall while walking. The severity of the fractures depends on the intensity of the fall as well as the strength of the bone.
Preferred treatment option:
Undisplaced stable fractures can be treated conservatively with bed rest for 4-6 weeks.
Unstable fractures and multi-fragmentary fractures are treated using “keyhole” surgery known as proximal femur nailing under ultrasound-guided regional Anesthesia (wide awake surgery)
Recovery time:
As mentioned above, in stable fractures treated conservatively, the patients are usually suggested 6 weeks of bed rest before starting out-of-bed mobilisation activities.
Here at Sri Balaji Hospital, individuals who have sustained unstable fractures and subsequently undergone key-hole surgery known as Proximal Femur Nailing (PFN) are often made to walk anytime within 24 hours, and once mobilised, they can walk as much as they like.
These are breakages in the bone (fractures) that occur close to the ball of the ball and socket joint.
Cause of injuries:
Slip & fall while walking. Fall in the sitting position.
Preferred treatment option:
Impacted stable fractures can be treated conservatively with bed rest for 4-6 weeks.
In individuals with no associated medical illnesses and who have healthy bone quality AND report within 2-3 hours following the injury, keyholed X-ray guided key-hole screw fixation of the fracture to retain the natural bone is performed with great success rates.
Unstable fractures and multi-fragmentary fractures often require a surgery known as bipolar arthroplasty (partial hip replacement) under ultrasound-guided regional Anesthesia (wide awake surgery)
Recovery time:
As mentioned above, in stable fractures that are treated conservatively, the patients are usually suggested with 4 to 6 weeks of bed rest before starting out-of-bed mobilisation activities.
Here at Sri Balaji Hospital, individuals who undergo key-hole screw fixation are usually started on out-of-bed independent mobilisation using a walker (walking frame) within 24 hours but WITHOUT applying pressure on the operated hip/ limb. Usually, this method of walking is taught on day 1 and continued for up to 4 and 6 weeks after surgery. Following the 6-week period, the patient can gradually step up their weight bearing on the operated hip to regain normal walking activities.
Here at Sri Balaji Hospital, individuals who have sustained unstable fractures and subsequently undergone partial hip replacement are often made to walk anytime within 24 hours, and once mobilised, they can walk as much as they want.
These fractures occur due to falls, resulting in a crack/ fracture in the pelvic girdle.
Cause of injuries:
Slip & fall while walking. High impact/ force injuries such as falls from height/ staircase/ 2-wheelers.
Preferred treatment option:
Recovery time:
As mentioned above, in stable fractures that are treated conservatively, the patients are usually suggested with 4 to 6 weeks of bed rest before starting out-of-bed mobilisation activities.
Patient’s whose fractures were severe enough to require plate and screw fixation are allowed to get out of bed within 24 hours and move around using a walking frame WITHOUT applying weight on the operated hip & limb for a period of 4 to 6 weeks following which their permissible walking levels are gradually increased until normal return to activities within 3 months.
The ankle joint is a complex joint involving 4 bones, namely, the lower end of the shin bone (tibia) , the lower end of the outer thin bone (fibula) and the bone connecting the ankle and foot (talus).
Cause of injuries:
The most typical reason is twisting of the ankle (simple or violent), resulting in breakage of the tibia and the Fibular ends. The severity of this will depend upon the bone strength vs. the force of the twisting injury. Other high-velocity injuries, including 2-wheeler injuries and fall from height injuries, can result in similar fractures to the tibia, fibula, and talus fractures.
Preferred treatment option:
Recovery time:
In both cases the patient is allowed to get out of bed and walk without bearing weight on the injured limb for 4 to 6 weeks (depending on severity of injury) before gradually being rehabilitated to resume normal walking.
These fractures are another common type of fracture encountered in elderly agents and involves the ball of the upper arm (also known as the head or neck of humerus)
Cause of injuries:
Fall at the individual's residence, usually involving a fall on the outstretched hand or on the side of the shoulder resulting in direct blow to the upper end of the humerus. Other causes could include high velocity injuries following road traffic accident injuries.
The severity of the fractures depends on the force of impact and the bone strength.
Preferred treatment option:
Shoulder Replacement (under ultrasound guided regional Anesthesia ‘wide awake surgery’) is reserved for individuals whose fractures are too severe and non-correctable by surgeries using plates & screws. Shoulder replacement surgery for such fractures maybe total shoulder replacement (when the shoulder fracture involves cracks to the ball as well as the socket of shoulder joint) or partial shoulder replacement (where only the shattered ball of the ball & socket joint is replaced without disturbing the normal anatomy of the socket of shoulder joint).
Recovery time:
In individuals who have been treated non operatively the shoulder joint will be immobilised for a period of 4-6 weeks before starting him/ her on gradual shoulder movement exercises and gradually by the 8th to 12th week, the individual is started on shoulder strengthening exercises before being lower to resume all daily activities.
In individuals whose shoulder fractures are treated surgically (surgical fixation of fracture as well as shoulder joint replacement) movement of the injured shoulder is started within 24 hours and the patient is allowed to carry out all his/ her daily activities within 2 weeks.
These fractures are another common type of fracture encountered in elderly agents and are associated with falls on the outstretched hand.
Cause of injuries:
Fall at the individual's residence, usually involving a fall on the outstretched hand. Other causes could include high-velocity injuries following road traffic accident injuries. The severity of the fractures depends on the force of impact and the bone strength.
Preferred treatment option:
The type of treatment mainly depends on factors such as the severity of the fracture/ fractures (simple fracture or multiple fragment fractures) and cracks extending into the joint.
Depending on these factors:
Non-operative management for simple fractures and the cracks DO NOT EXTEND into the joint surface. This treatment follows the principle of immobilisation of the simple fracture with the help of a POP cast and using a sling to support the injured wrist for 2-4 weeks, depending on the severity of the fracture and bone quality.
Surgical stabilisation using plates and screws (under ultrasound-guided regional Anesthesia- ‘wide awake surgery’) is reserved for fractures that comprise multiple fragments which have cracked into the joint surface.
Recovery Period:
In individuals whose wrist fractures are treated surgically, movement of the injured wrist is started within 24 hours, and the patient is allowed to carry out all their daily activities within 2 weeks.
These are relatively common fractures in elderly individuals as the spine is one of the first bones to lose bone density and the mechanics of the spine is such that the lack of bone strength can often result in spine fractures even with little to no injuries to the spine. Hence, even the simplest of manoeuvres to a weak spine such as bending forward to pick up weight (without an actual history of falls or trauma to the body) can leave the spine most vulnerable to osteoporotic stress fractures. Similarly, in the case of falls/ injuries, the loading weight on the spine in addition to the force of injury that the individual's spine is susceptible to can result in compression fractures.
Cause of injuries:
Preferred treatment option:
The type of treatment mainly depends on factors such as:
Depending on these factors:
Non-operative management for simple wedge compression fractures which have retained significant height even after the compression and do not pose a threat to the spinal cord or risk of progressive spinal deformity.
In case of stable spine fractures which pose no threat to the spinal cord but cause severe prolonged pain of the back, an alternative minimally invasive option of treatment involves a day care procedure known as Vertebroplasty or kyphoplasty under local Anaesthesia.
Surgical spinal stabilisation using rods and screws are reserved for “burst” fractures which are unstable, pose a risk of spinal cord injuries (or have already resulted in a spinal cord injury) or the the fractured vertebrae is too severely crushed to achieve any adequate restoration of the height of the vertebral body via minimally invasive procedures such as Vertebroplasty/ kyphoplasty.
Recovery Period:
In spine fractures where conservative or non operative modality of management is pursued, the individual will require a minimum of 4 weeks of STRICT bed rest following which the patient is then reassessed and started on walking exercises and other spinal rehabilitation activities.
In individuals who have undergone minimally invasive treatment (Vertebroplasty or kyphoplasty) the patient is mobilized immediately after the procedure (pain-free) and is allowed to walk with no restrictions. The patient is then allowed to resume all his/ her routine activities within 5 to 7 days.
In individuals upon whom spinal stabilization surgery is performed, the individual is allowed to get out of bed and start walking within 24 hours and can resume all activities within 2 weeks.
