Why are fractures common in the elderly

Osteosynthesis procedures of the most common fractures

The osteosynthesis procedures for the four most common fractures we treat are:

Distal radius fracture (forearm fracture near the wrist)

The fracture of the forearm near the wrist is the most common bone fracture in humans, accounting for up to 25%. It usually arises from a fall on the outstretched hand. It occurs most frequently in children and adolescents, but also in older women with already osteoporotic (bone loss) bone. The patients complain of swelling in the wrist with pain-related loss of mobility. In some cases, a misalignment of the wrist can already be recognized from the outside, then attention must also be paid to sensory and circulatory disorders in the hand.

After the clinical examination, an X-ray of the wrist is taken. The images are then used to decide whether an operation is necessary. If there is a misalignment or a step in the joint surface that cannot be remedied by plastering alone, the fracture (broken bone) should be treated surgically. The fracture area is exposed via a skin incision lengthways on the forearm close to the wrist on the side of the palm and the individual fracture fragments (fragments) can be returned to their anatomical position like a puzzle. This reduced (set up) situation is fixed by means of a plate fixation. Angle-stable plate fixation has been established since the 1990s because, on the one hand, it allows the patient to undergo physical therapy immediately. On the other hand, with the earlier non-angularly stable implants, the fracture tipped again more frequently with healing in the malposition and possibly the associated loss of function.

After such an operation, the patient only needs to stay in the hospital for a short time (usually 2-4 days). Physiotherapy is started on the first day and the patient is discharged without a plaster cast, but only with a Velcro orthosis. After six weeks, the fracture has healed and the patient can begin to fully strain his wrist again (carrying heavier objects, propping up).
 

Humeral head fracture

The humerus head fracture is a common fracture in humans, accounting for 4-5% of all fractures. The incidence increases with age due to decreasing bone density. It usually arises from a fall on the outstretched arm. Patients often complain of a pain-related loss of mobility in the affected shoulder joint, with the pain radiating to the upper arm. In young patients, accompanying nerve injuries are more common because of the greater trauma required.

After the clinical examination, an x-ray of the shoulder is taken. Based on the images, a decision is made about the necessity and, if necessary, the type of surgery. In the case of non-displaced fractures (broken bones), a conservative approach should always be sought. The decisive factor for the correct surgical procedure is how many parts of the humerus head is fractured. The more fragments there are, the greater the likelihood that there will be insufficient blood supply to the head of the humerus and that bone necrosis (death of the bone) will develop over time. For the precise assessment of the fracture and for the planning of the operation, computed tomography (CT) is usually carried out for a better assessment. If it is a fracture for which sufficient blood flow can be assumed, the fracture area is exposed via a skin incision on the shoulder and the individual fragments can be returned to their anatomical position like a puzzle. The repositioned (set up) humerus head is fixed by means of an angle-stable plate fixation. In the case of a fracture of the humerus head consisting of many fragments, there is no longer sufficient blood flow, so that a humeral head prosthesis must be implanted here. The same is necessary if the joint surface is completely destroyed.

After such an operation, the patient must stay in the hospital for about 7-10 days. First the arm is immobilized in a Gilchrist bandage, but physiotherapy is started from the bandage on the first day. The patient no longer needs the Gilchrist bandage after about a week. Depending on the patient's wishes, a rehabilitation measure can be added if necessary.
 

Femoral neck fracture

The femoral neck fracture is a typical fracture in the elderly. In younger people, a comparatively large amount of force is required for a femoral neck fracture. It usually arises from a fall on the hip. The patients complain of at least one pronounced pain on exertion, often pain-related loss of mobility in the corresponding hip with immobilization, and sometimes also with a typical shortening and external rotation malalignment of the leg.

After the clinical examination, a hip x-ray is taken. The type of operation is then decided on the basis of the images. A conservative approach without surgery is only very rarely possible. The location of the fracture in the area of ​​the femoral neck is decisive for the correct osteosynthesis procedure. Furthermore, a pre-existing arthrosis (joint occlusion) in the joint has an influence on the further operative procedure. Basically, a distinction is made between femoral neck fractures near the femoral head (medial) and distal femoral head (lateral) fractures, as well as fractures in the area of ​​the large and small rolling hillocks (pertrochanteric femur fracture). In the femoral neck fracture near the femoral head, the blood flow to the femoral head plays a decisive role. If it can be assumed that the blood circulation is preserved, the operation can be performed in a head-saving manner. Three long screws are inserted through the femoral neck into the femoral head via a small skin incision on the side of the hip (screw osteosynthesis). If the blood supply to the femoral head is no longer guaranteed, an endoprosthetic treatment must be provided. Either a partial endoprosthesis without a socket component or a total hip endoprosthesis in the case of pre-existing osteoarthritis can be selected. In the case of femoral neck fractures far from the femoral head or fractures in the area of ​​the rolling hills, an intramedullary (within the bone marrow) osteosynthesis is usually sought. The fracture area does not have to be exposed, but the fracture can be straightened by pulling on the leg and a nail can be inserted into the medullary canal for internal splinting through a small skin incision over the large hillock (greater trochanter). This is followed by a screw in the femoral neck axis and one or two more screws further towards the foot for fixation. Even with this fracture localization, the implantation of a total hip endoprosthesis makes sense in the presence of symptomatic osteoarthritis.

After such an operation, the patient usually has to stay in the hospital for about 10-14 days. A partial load for 6 weeks is required for head-conserving surgery with screw osteosynthesis alone. All other forms of care allow an immediate full load. Physiotherapy and the first walking exercises are started on the first day. Depending on the patient's wishes and physical condition, rehabilitation measures can often be added before the accident.
 

Ankle fracture

The ankle fracture is one of the most common fractures (broken bones) in adults. It usually arises from a fall or a misstep with ankle twisting of the upper ankle. As a rule, patients complain of significant stress pain with pain-related loss of mobility in the upper ankle joint and often pronounced swelling with tenderness in the area of ​​the outer and / or inner ankle. In some cases, a malposition of the ankle can already be recognized from the outside, then attention must be paid to sensory and circulatory disorders of the foot and a quick reduction (straightening) must be carried out.

After the clinical examination, an X-ray of the upper ankle is taken. The images are then used to decide whether an operation is necessary. The position of the ankle joint fork is assessed. It is formed on the outside by the fibula distant from the body as the outer ankle and on the top and inside (inner ankle) by the distant shin and includes the talus. In addition, the calf and shin bones are firmly connected to form a “fork” through syndesmosis, a firm ligament structure. Intact syndesmosis is crucial for stability in the upper ankle. In the case of a single fracture of the outer ankle, it may be intact and conservative treatment is permitted (Weber A fracture). If the outer ankle is broken in such a way that the syndesmosis is also injured (Weber B and C fractures), surgical treatment is required. The fracture area is exposed via a skin incision directly above the outer ankle, the individual fragments (fragments) can be returned to their anatomical position like a puzzle and then fixed and splinted using a lag screw and a third-tube plate. With this reduction, the exact restoration of the ankle joint is crucial in order to avoid later post-traumatic arthrosis (joint wear). To stabilize the injured syndesmosis, a so-called set screw is inserted through the plate from the outside across the fibula and into the shin. At the same time, there may be a fracture of the inner ankle (bimalleolar fracture) or an additional fracture of the posterior edge of the tibia as a Volkmann triangle (trimalleolar fracture). These fractures can usually be treated with screw fixation. If, however, there is pronounced swelling of the soft tissue when an operation is necessary, the swelling should first be awaited by immobilizing the plaster of paris and elevating the patient.

The length of the inpatient stay after such an operation depends on the soft tissue situation and wound healing. Due to the low soft tissue coverage, wound healing disorders and infections are more common than after other fracture osteosyntheses. Therefore, after the operation, the patient is immobilized in a lower leg cast until the ankle is largely swollen. Depending on the severity of the fracture and the skill of the patient on forearm crutches, treatment can then also be carried out without a plaster of paris. Alternatively, a further immobilization can take place in a lower leg orthosis with a special vacuum support system. As a rule, until the set screw is removed, which can be done 6 weeks after the operation, only mobilization with a 10kg rolling load is allowed.