Postural Stability in Older Adults with a Distal Radial Fracture

Louer, Craig R.; Boone, Sean; Guthrie, Andre; Motley, John; Calfee, Ryan P.; Wall, Lindley B.

doi:10.2106/jbjs.15.00963

Cited by 30 publications

(27 citation statements)

References 36 publications

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“…(35,36) Increased postural sway translates into falls, which in the presence of low BMD, further elevates the risk for injuries. (37)(38)(39) Adding postural sway to fracture risk prediction tools might improve their predictive capability. Multiple components of postural sway have previously been suggested to associate with FRAX®.…”

Section: Discussionmentioning

confidence: 99%

High Postural Sway Is an Independent Risk Factor for Osteoporotic Fractures but Not for Mortality in Elderly Women

Qazi

Sirola

Kröger

et al. 2019

Journal of Bone and Mineral Research

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The aim of this prospective cohort study was to investigate the independent effect of postural sway on overall fracture and osteoporotic fracture risk after controlling for other established fracture risk factors. As a secondary outcome, mortality was also investigated. The study sample is a stratified random sample of 1568 women born between 1932 and 1941, residing in Kuopio province, eastern Finland. Fracture data were obtained through study questionnaires and verified through hospital records. Mortality data were verified through the National Registry. Using static posturography, postural sway was recorded for 1568 women at the fifth year of follow‐up in 1994 through 1997. Mediolateral (ML), anteroposterior (AP), and total sway parameters were used for analysis. Mean follow‐up time for any fractures, osteoporotic fractures, and mortality was 10.6, 11.4, and 17.5 years, respectively. After adjustment, subjects in the highest quartile of ML sway (HR, 2.0; 95% CI, 1.5 to 2.8) and total sway (HR, 1.6; 95% CI, 1.2 to 2.2) had a higher risk for any fracture. Osteoporotic fracture risk was also higher in the fourth quartile of ML sway (HR, 1.9; 95% CI, 1.1 to 3.0) and total sway (HR, 1.7; 95% CI, 1.0 to 2.8). The models were adjusted for fracture risk assessment tool risk factors and leg‐extension strength. Further, women having both lowest bone density and highest postural sway were at 4.9 (95% CI, 2.6 to 9.5) times higher risk of overall fracture and 11.8 (95% CI, 2.7 to 51.3) times higher risk for osteoporotic fracture in comparison with subjects having highest bone density and lowest postural sway. The association between postural sway and mortality was not significant after adjustment. In conclusion, high postural sway is an independent risk factor for any fractures as well as for osteoporotic fractures. A combination of low bone density and high postural sway poses even higher fracture risk than either factor alone. Postural sway does not predict mortality independently. © 2019 American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

High Postural Sway Is an Independent Risk Factor for Osteoporotic Fractures but Not for Mortality in Elderly Women

Qazi

Sirola

Kröger

et al. 2019

Journal of Bone and Mineral Research

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“…The occurrence of distal radius fractures is well known to be a sentinel event, as these fractures are associated with a two to four times increased risk of subsequent hip fractures in elderly patients [7][8][9]. This is an important concept, as it is well established that these patients have an increased risk of falling [8].…”

Section: Introductionmentioning

confidence: 99%

“…Recent evidence has shown that the prevalence of sarcopenia reaches up to 95% in male and 64% in female patients after an osteoporotic fracture [12]. The instability of these patients has also been validated with the use of objective measurements from computerized instruments [9].…”

Section: Introductionmentioning

confidence: 99%

“…Despite on-going studies on distal radius fractures, the latest Cochrane systematic review shows a lack of evidence on the effectiveness of current rehabilitation interventions [13]. The American Academy of Orthopaedic Surgeons (AAOS) position statement also recommends patients with fragility fractures to undergo evaluation of osteoporosis and treatment to prevent future fractures [9]. Notably, there are currently no recommendations on the role of balance training or physical conditioning.…”

Section: Introductionmentioning

confidence: 99%

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A study protocol for a randomized controlled trial evaluating vibration therapy as an intervention for postural training and fall prevention after distal radius fracture in elderly patients

Wong

Tso

et al. 2020

Trials

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Background: Fractures of the distal radius are one of the most common osteoporotic fractures in elderly men and women. These fractures are a particular health concern amongst the elderly, who are at risk of fragility fractures, and are associated with long-term functional impairment, pain and a variety of complications. This is a sentinel event, as these fractures are associated with a two to four times increased risk of subsequent hip fractures in elderly patients. This is an important concept, as it is well established that these patients have an increased risk of falling. Fall prevention is therefore crucial to decrease further morbidity and mortality. The purpose of this study is to investigate the effect of low-magnitude high-frequency vibration (LMHFV) on postural stability and prevention of falls in elderly patients post distal radius fracture.Methods: This is a prospective single-blinded randomized controlled trial. Two hundred patients will be recruited consecutively with consent, and randomized to either LMHFV (n = 100) or a control group (n = 100). The primary outcome is postural stability measured by the static and dynamic ability of patients to maintain centre of balance on the Biodex Balance System SD. Secondary outcomes are the occurrence of fall(s), the health-related quality of life 36-item short form instrument, the Timed Up and Go test for basic mobility skills, compliance and adverse events. Outcome assessments for both groups will be performed at baseline (0 month) and at 6 weeks, 3 months and 6 months time points. Discussion: Previous studies have stressed the importance of reducing falls after distal radius fracture has occurred in elderly patients, and an effective intervention is crucial. Numerous studies have proven vibration therapy to be effective in improving balancing ability in normal patients; However, no previous study has applied the device for patients with fractures. Our study will attempt to translate LMHFV to patients with fractures to improve postural stability and prevent recurrent falls. Positive results would provide a large impact on the prevention of secondary fractures and save healthcare costs. Trial registration: ClinicalTrials.gov, NCT03380884. Registered on 21 December 2017.

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“…In the older adult, osteoporosis and poor postural stability are associated with these fractures after falls onto an outstretched hand [1,[6][7][8]9•]. Distal radius fracture in young patients usually occurs in the setting of play or sports and accounts for 23% of all sports-related fractures in adolescents [10].…”

Section: Introductionmentioning

confidence: 99%

Distal radius fractures in the athlete

Beleckas

Calfee

2017

Curr Rev Musculoskelet Med

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Purpose of Review Distal radius fractures are one of the most common upper extremity fractures. Athletes with distal radius fractures are treated according to the same principles as nonathletes but present several unique considerations. At all levels of sport, injured athletes desire to return to play as rapidly as possible. Recent Findings Earlier operative fixation may allow an athlete to return to play more quickly. Volar locking plates are most commonly used for operative treatment of distal radius fractures due to their stability and low incidence of complications. Summary Although the majority of distal radius fractures in athletes are treated non-operatively, operative intervention is offered when required to restore and maintain acceptable skeletal alignment. Return to sport is individualized guided by fracture stability, athlete age, and wrist-specific demands for competition.

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Postural Stability in Older Adults with a Distal Radial Fracture

Cited by 30 publications

References 36 publications

High Postural Sway Is an Independent Risk Factor for Osteoporotic Fractures but Not for Mortality in Elderly Women

High Postural Sway Is an Independent Risk Factor for Osteoporotic Fractures but Not for Mortality in Elderly Women

A study protocol for a randomized controlled trial evaluating vibration therapy as an intervention for postural training and fall prevention after distal radius fracture in elderly patients

Distal radius fractures in the athlete

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