What Factors Contribute to Falls-Related Distal Radius Fracture?

Philip, Sheena Saju; MacDermid, Joy C.; Nair, Saranya; Walton, Dave; Grewal, Ruby

doi:10.1123/japa.2017-0428

Cited by 6 publications

(4 citation statements)

References 33 publications

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“…This is consistent with age-related mechanism differences where young males are more likely to incur high trauma or “misfortune” fractures, whereas older females incur a DRF/PHF with low trauma as is typical for a bone-compromised or fragility fracture. This concurs with our mixed methods study of causes of DRF where we examined quantitative data from a cohort of more than 1400 patients [ 17 ]. We found that low trauma fractures were more common in those over 45 years of age, and high trauma fractures occurred most often in the youngest (18–24-year-old) group.…”

Section: Discussionsupporting

confidence: 87%

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Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario

MacDermid

McClure²,

Richard³

et al. 2021

BMC Musculoskelet Disord

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Background Understanding the profiles of different upper extremity fractures, particularly those presenting as a 1st incident can inform prevention and management strategies. The purpose of this population-level study was to describe first incident fractures of the upper extremity in terms of fracture characteristics and demographics. Methods Cases with a first adult upper extremity (UE) fracture from the years 2013 to 2017 were extracted from administrative data in Ontario. Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve, or tendon injury) were described by fracture type, age category and sex. Standardized mean differences of at least 10% (clinical significance) and statistical significance (p < 0.01) in ANOVA were used to identify group differences (age/sex). Results We identified 266,324 first incident UE fractures occurring over 4 years. The most commonly affected regions were the hand (93 K), wrist/forearm(80 K), shoulder (48 K) or elbow (35 K). The highest number of specific fractures were: distal radius (DRF, 47.4 K), metacarpal (30.4 K), phalangeal (29.9 K), distal phalangeal (24.4 K), proximal humerus (PHF, 21.7 K), clavicle (15.1 K), radial head (13.9 K), and scaphoid fractures (13.2 K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8 K), fractures occurring in multiple regions of the upper extremity (8.7 K), or multiple regions in the forearm (8.4 K). Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries were rarely reported (0.3% overall, 1.5% in distal humerus). Fractures were reported as being open in 4.7% of cases, most commonly for distal phalanx (23%). A similar proportion of females (51.5%) and males were present in this fracture cohort, but there were highly variant age-sex profiles across fracture subtypes. Fractures most common in 18–40-year-old males included metacarpal and finger fractures. Fractures common in older females were: DRF, PHF and radial head, which exhibited a dramatic increase in the over-50 age group. Conclusions UE fracture profiles vary widely by fracture type. Fracture specific prevention and management should consider fracture profiles that are highly variable according to age and sex.

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Section: Discussionsupporting

confidence: 87%

“…Environmental factors are known contributors to fracture [ 17 ]. Fractures that occurred more often in the winter months included the classic fragility fractures (DRF, PHF) and olecranon fractures which often occur due to falls from level ground in slippery conditions.…”

Section: Discussionmentioning

confidence: 99%

Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario

MacDermid

McClure²,

Richard³

et al. 2021

BMC Musculoskelet Disord

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“…These fragility fractures typically occur with low trauma, such a fall from level ground. The sexage patterns in our PHF and DRF data concurs with ndings from our mixed methods study where quantitative data from a cohort of more than 1400 patients with DRF [28] indicated that low trauma was more common in those over 45 years of age, and high trauma occurred most in the youngest (18-24-year-old) group. In the qualitative part of that study, we found the factors contributing to fractures included environment, risk taking behaviors, physical factors, and sports activities.…”

Section: Discussionsupporting

confidence: 88%

Sociodemographic, health and fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures in Ontario.

Jc¹,

McClure²,

Richard³

et al. 2020

Preprint

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Background The purpose of this study was to describe 1st incident fractures of the upper extremity in terms of fracture characteristics, demographics, social deprivation and comorbid health profiles. Methods:Cases with a 1st adult upper extremity fracture from the years 2013 to 2017 were extracted from administrative data in Ontario, (population 14.3M). Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve or tendon injury) were described by fracture type, age category and sex. Fracture comorbidity characteristics were described in terms of the prevalence of diabetes, rheumatoid arthritis; and the Charlson Comorbidity Index. Social marginalization was expressed using the Ontario Marginalization Index (ON-Marg) for material deprivation, dependency, residential instability, ethnic concentration. ResultsFrom 266,324 first incident UE fractures occurring over 4 years, 51.5% were in women and 48.5% were in men. This masked large differences in age-sex profiles. Most commonly affected were the hand (93K), wrist/forearm(80K), shoulder (48K) or elbow (35K). The highest number of fractures: distal radius (DRF, 47.4K), metacarpal (30.4K), phalangeal (29.9K), distal phalangeal (24.4K), proximal humerus (PHF, 21.7K), clavicle (15.1K), radial head (13.9K), and scaphoid fractures (13.2K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8K), fractures occurring in multiple regions of the upper extremity (8.7K), or multiple regions in the forearm (8.4K). Fractures most common in 18 – 40-year-old men included metacarpal and finger fractures. A large increase in fractures in women over the age of 50 occurred for: DRF, PHF and radial head. Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries (0.3% overall, 1.5% in distal humerus) were rarely reported. Fractures were open in 4.7%, highest for distal phalanx (23%). Diabetes occurred in 15.3%, highest in PHF (29.7%). Rheumatoid arthritis occurred more commonly in women (2.8% vs 0.8% men). The Charlson Index indicated low comorbidity (mean=0.2; median=0: 2.4% 3+), highest in PHF (median=0; 6.6% 3+). Higher fracture burden was related to instability (excess of fractures in lower 2 quartiles 4.8%), although social indices varied by fracture type. ConclusionsFracture specific prevention strategies should consider fracture-specific age-sex interactions, health, behavioural and social risks

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“…Unfortunately, no factors were identified that were associated with injurious falls, suggesting other variables (e.g., environmental, behavioral, medications) [ 29 , 50 , 51 ] may be important factors for subsequent falls-related inquiries. Future investigations may build on these cross-sectional findings by prospectively evaluating identified factors as predictors of (or protectors from) multiple falls, over time in a cohort of adolescents and adults with AMC.…”

Section: Discussionmentioning

confidence: 99%

Falls and Associated Factors among Adolescents and Young Adults with Arthrogryposis Multiplex Congenita

Sions

Donohoe

Beisheim

et al. 2021

Int J Rare Dis Disord

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Background: Falls research among individuals with arthrogryposis multiplex congenita (AMC), a group of congenital conditions characterized by joint contractures in two or more body regions, is sparse. The primary objectives of this study were to estimate the prevalence of single, multiple, and injurious falls among adolescents and adults with AMC and identify factors associated with multiple and injurious falls.Methods: Individuals, aged 10-50 years, with a diagnosis of AMC completed questionnaires obtaining demographic and AMC-specific information, falls history (e.g., number, injurious/non-injurious), markers of bone health, orthopedic surgical history, and mobility aid use, as well as the Gillette Functional Assessment Questionnaire and the Saltin-Grimby Physical Activity Level Scale. Falls were defined as "any body part above the ankle coming to rest on the ground, floor, or a lower level". Falling was defined as ≥ 1 fall, while multiple falls were defined as ≥ 2 falls in the past year.Differences in falling, multiple falls, and injurious falls rates between adolescents (10-17 years) and adults (aged 18-50 years) were evaluated. Using univariate binary logistic regression models, associations between participant characteristics and multiple falls, as well as injurious falls, were evaluated, while considering age as a covariate (p ≤ 0.050); odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.Results: Adolescents (N = 28; median age = 14 years) and adults (N = 40; median age = 32 years) with AMC had similar falling, i.e., 89.3% versus 70.0%, and injurious fall rates, i.e., 32.1% versus 27.5%, respectively (p > 0.050).Adolescents with AMC, however, were more likely to report multiple falls in the past year, i.e., 89.3%, when compared to adults with AMC, i.e., 57.5% (p = 0.005). Beyond age, multiple falls were associated with a greater number of lowerlimb surgeries [p = 0.036, OR (95%CI): 1.18 (1.01-1.39)], ability to transfer floor-to-stand with support [p = 0.002, OR (95%CI): 8.98 (2.30-35.06)], and increased mobility per the Gillette Functional Assessment Questionnaire [p = 0.004, OR (95%CI): 1.48 (1.13-1.92)]. Factors associated with a reduced odds of multiple falls were spinal involvement [p = 0.025, OR (95%CI): 0.23 (0.07-0.84)], history of spinal surgery [p = 0.018, OR (95%CI: 0.18 (0.04-0.74)], greater upper extremity involvement [OR (95%CI): 0.65 (0.44-0.95)], home assistive device use [p = 0.010, OR (95%CI): 0.15 (0.03-0.63)], and community wheelchair use [p = 0.006, OR (95%CI): 0.16 (0.04-0.59)]. None of the explored characteristics were associated with injurious falls in the past year (p > 0.050). Conclusion:Falls are exceedingly common among adolescents and adults with AMC; potential risk and protective factors for multiple falls are identified for future prospective falls research.

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What Factors Contribute to Falls-Related Distal Radius Fracture?

Cited by 6 publications

References 33 publications

Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario

Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario

Sociodemographic, health and fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures in Ontario.

Falls and Associated Factors among Adolescents and Young Adults with Arthrogryposis Multiplex Congenita

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