Anatomy Physiology

When a person ages, there are certain structural changes that takes place in many organs of the body. Bones are one of the organs which see a significant change in its structural integrity with the losing of mineralization, proteins, as well as the micro structure. The ultimate result would be fragile bones which can get fractured to even a mild stress.

While considering the prevalence, it’s apparent to see that the females are slightly more susceptible for such fractures than the men, probably due to the higher prevalence of osteoporosis in postmenopausal women.

Even though the weakening of bones are a general occurrence in almost all the bones in the body, there are few sites which are seen commonly in fractures related to the elderly age group. These would be,

* At the distal end of the radius bone in the arm

* Neck of the humeral bone in the upper arm

* Neck of the femoral bone in the leg

* Vertebral fractures

Fracture of the distal end of the radius / Colles’ fracture:

The condition is a common occurrence in the elderly person who falls on a outstretched hand and would be characterized by shortening of the affected limb, deviation away from the body while in the neutral position and a characteristic deformity known as ‘dinner fork deformity’. Apart from these deformities, it would be associated with intense pain and swelling as well.

These fractures would have to be reduced under anesthesia to relieve its impaction, and a cast would be applied that may have to keep for 6-7 months. Elevating the arm and placing the arm in a sling can also be done for the initial few days following a fracture.

Neck of the femur fracture:

Probably one of the most common fractures in the elderly, it can occur following a fall or after a high impact to the region. The nature of these fractures are such that unless an intervention does not take place, the blood supply to the fractured pieces in the head and the neck of the femur can become disrupted and thus lead to necrosis and related complications.

Following a fall, there can be intense pain, tenderness in the area, shortened leg as well as partial rotation of the leg. The peripheral circulation will most probably be intact and the mobility of the joint would be severely restricted.

These fractures are treated by inserting an artificial screw to hold the fractured pieces together or else by inserting a artificial head and neck for the bone.

Humerus fracture:

When an elderly person falls on an outstretched arm or else is suffering from osteoporosis, they are at risk of developing a proximal humerus fractures, possibly in the surgical neck of the humerus.

These patients will complain of pain, swelling as well as at times echymotic patches in the affected region. Placing the arm in a sling would be the treatment option for uncomplicated cases and gradual introduction of the arm and the joints towards full range of mobilization is considered essential in order to avoid disabilities such as ‘frozen shoulder’ due to prolonged immobilization.

Vertebral fractures:

Most often these fractures are due to falls and the likelihood is being increased with the presence of osteoporosis and malignancies. The main complaints of such stress fractures would be the sudden onset of back pain which sometimes runs down the legs following a fall or at times of lifting a heavy object.

The treatment options would mainly be conservative and adequate pain relief, rest and gradual mobilization would be the mainstay of treatment.