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PubMed2000

The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls.

The risk factors for falls in older adults are well known but knowledge on the direct injury mechanisms that result in various osteoporotic fractures has been very sparse. The purpose of this study was therefore to clarify the injury mechanisms of osteoporotic upper extremity fractures of older adults and to compare these mechanisms with those of the control fallers, and in this way to obtain reliable insight into the etiology and pathogenesis of upper extremity fractures and thus to enable fracture prevention. One hundred and twelve patients with a fresh fracture of the proximal humerus, 65 patients with an elbow fracture, 110 patients with a wrist fracture and 108 controls (no fracture, or a fracture other than the case fracture) were interviewed and examined between September 1995 and December 1997. The inclusion criteria of the subjects were that the patient was 50 years of age or older at the time of the accident, and that the fracture/injury had occurred as a result of low-energy trauma (typically a fall from standing height or less) within a week before the interview and examination. In 97% of patients with a proximal humerus or elbow fracture, and in all patients (100%) with a wrist fracture, the fracture was a result of a fall. In the control group this figure was 93%. In a polychotomous logistic regression analysis the intergroup differences in the fall directions (adjusted by gender, age and functional capacity) were statistically highly significant (chi 2 = 43.6, d.f. = 15, p < 0.001). Most of the patients with a proximal humerus fracture or elbow fracture reported that they had fallen 'obliquely forward' (43% and 38%) or 'to the side' (29% and 26%), whereas in the wrist fracture group the main fall direction was also 'obliquely forward' (34%) but the other fall directions (i.e., 'forward', 'to the side', 'obliquely backward' and 'backward') were quite equally represented (13-19%). The odds ratio (OR) for an obliquely forward fall resulting in a proximal humerus fracture was 3.5 [95% confidence interval (CI) 1.4-9.2), as compared with the fall directions of the controls and the 'obliquely backward' fall direction. In a logistic regression analysis the patients with a wrist fracture managed to break their fall (e.g., with an outstretched arm) more frequently than the patients in the other groups (OR 3.9; 95% CI 2.0-7.3). The patients with a proximal humerus fracture, in turn, managed to break their fall less frequently than the controls (OR 0.33; 95% CI 0.14-0.80). The same was true of the patients with an elbow fracture, although the difference was not significant (OR 0.49%; 95% CI 0.19-1.3). As objective evidence for a direct fall-induced impact on the fracture site, 68% of patients with a proximal humerus fracture revealed a fresh subcutaneous hematoma on the shoulder/upper arm, while such a hematoma was rare in the controls (2%) (p < 0.001). Correspondingly, 62% of patients with an elbow fracture showed a similar hematoma on the elbow area, while this was seen in none of the controls (p < 0.001). In patients with a wrist fracture a hand/wrist hematoma was seen in 58% of the victims, as compared with 18% of the controls (p < 0.001). The study shows that the most typical osteoporotic upper extremity fractures of older adults have their specific injury mechanisms. A great majority of these fractures occur as a result of a fall and a subsequent direct impact of the fractured site. Effective fracture prevention could be achieved by minimizing the obvious risk factors of falling and reducing the fall-induced impact force with injury site protection.

Accidental Falls↗

PubMed2005

Locking of retractable type fall arresters--test method and stand.

Retractable type fall arresters are very effective personal equipment protecting against falls from a height. These devices are used under different atmospheric conditions and in the presence of various types of industrial pollution. For this reason appropriate locking after conditioning simulating extreme conditions of a worksite is one of the essential characteristics of retractable type fall arresters. This article presents the requirements for locking of the devices. A previously used locking test method and its disadvantages are discussed. The article suggests an improved test method and test equipment. Measurement of the test mass acceleration is the most important improvement introduced into the test method. The article shows laboratory tests used to verify the method, which turned out to be a valuable source of information concerning the performance of retractable type fall arresters.

Acceleration↗

PubMed1995

Precocious puberty.

The past decade has seen tremendous advances in both the diagnosis and treatment options for children with precocious puberty. Although the precise cause of CPP is still not known, long-acting GnRH analogues provide a safe and effective form of therapy. Treatment slows the progression of secondary sexual characteristics and rates of linear growth and bone maturation. Although the final verdict on how beneficial GnRH analogue therapy is in preserving the final adult height in children with precocious puberty is still not in, achieved heights are generally greater than pretreatment predicted heights. However, treatment may not be appropriate for all children with GDPP. Some children progress through puberty slowly and may not have significant compromise in final height. Furthermore, some children who come from tall families who may be subject to the same deterioration from target height as children who come from short families may not require therapy because their expected final heights may still fall within an acceptable range even if they are shorter than their siblings. Therapy offers the greatest advantage for those children in whom the onset of puberty is at a very early age, those who demonstrate rapidly accelerating bone age, or those with lower genetic height potential. In the past 3 years, the molecular mechanisms by which precocious puberty develops in children with MAS and FMPP have been elucidated. The molecular defects characterized explain the clinical manifestations. Future challenges will include the development of an effective, targeted form of therapy for gonadotropin-independent forms of precocious puberty.

Child↗

PubMed2003

Jumpers and fallers: a comparison of the distribution of skeletal injury.

AIM: The aim of this study was to compare the distribution of injuries between patients who have fallen and those who have jumped from a height, and to relate the mechanism of injury to the fractures sustained. MATERIALS AND METHODS: Three hundred and ninety-nine patients, admitted via Helicopter Emergency Medical Service (HEMS), classified as either having fallen or jumped from a height were included in the study. The radiographs from the primary survey, together with radiographs of specific injury sites were analysed. The distribution of injury was compared in the two groups. RESULTS: Of the 399 patients, 342 were fallers and 57 were jumpers. Jumpers had a higher Injury Severity Score (ISS), death rate and number of fractures per person. Jumpers sustained more rib fractures (particularly on the right), pelvic and lower limb fractures but fewer skull fractures. CONCLUSION: Jumpers tend to sustain different injuries to fallers. It is proposed that jumpers have a tendency to land feet-first and then try to break their falls on their dominant side, sustaining more right-sided rib fractures in the process. The patterns of injury that have emerged from this study have important implications for evaluating skeletal injuries in those who jump or fall from a height.

Accidental Falls↗

PubMed1975

Effect of full agonists following calcium deprivation in rat vas deferens.

The contractile effects of maximum doses of adrenaline, noradrenaline, methacholine, acetylcholine, serotonin and barium chloride were studied following substitution of a medium without calcium for the normal nutrient solution. Except for the last agonist, the effects fall to about 10% within the first 3 min with prompt return to normal value upon reintroduction of regular fluid. This recovery is, however, slower if the previous incubation in Ca-free solution is prolonged. When barium chloride is used in a calcium-free medium, the maximum height of contractions falls exponentially at a t1/2 of about 180 min. This decay can be accelerated by giving successive 5-min doses of the agonist or by using EDTA. It is hypothesised that excitation--contraction coupling in rat vas deferens depends on at least two different calcium sources: a deep site associated with the effects of barium, and a superficial one, related to the other agonists. To explain the slow recovery after prolonged calcium lack, a third compartment in series with the latter is suggested. No indication is found that the biphasic effects of barium depend on two different calcium pools.

Acetylcholine↗

PubMed2002

[Diagnosis of the risk of accidental falls in the elderly].

The steep increase in the incidence of hip fractures and other fall-related fractures with advancing age is caused by an age-associated combination of increased fall frequency, typical fall mechanisms and reduced bone strength. This article reviews the current knowledge related to fall risk factors and fall mechanisms. Non-syncopal falls during normal daily activities are predominantly age-associated occurrences with serious consequences. 5% of all falls cause fractures, another 10 to 15% lead to a variety of further injuries. The most serious consequences of the geriatric fall syndrome are fractures of hip, humerus, wrist and pelvis. Fear of falling and self limitation of physical activity are self imposed psychological impairments. There is a pathological cascade from age-associated gait and balance disorders to locomotor falls and further to fall-related fractures. Significantly increased fall risk caused by gait and balance disorders can be considered as a distinct chronic pathological condition. It is strongly age-related and definitely has a multifactorial origin. The term "age-associated multifactorial gait disorder" has been coined for this condition. Assessing fracture risk requires evaluating fall risk, fall mechanisms and bone strength. Older people with gait and balance disorders fall mostly sideways, and the impact of such a fall from standing height generates enough force to break an older non-osteoporotic femur. Osteoporosis can decrease bone strength beyond the age-related grade, and is one of the several most important risk factors for fractures. Prospective studies have consistently found the following independent risk factors for non-syncopal falls: 1. Muscle power of lower extremities, 2. Lateral postural stability, 3. Clinical evaluation of gait, 4. Visual impairment, 5. Four or more different medications or certain psychotropic drugs, 6. Cognitive impairment, and 7. History of falling. The fall-related neuromuscular status can be adequately assessed by three diagnostic procedures: The chair rising test represents muscle power, and has proven its relevance for both fall risk and deterioration of mobility and functional independence. Measurement of lateral postural stability can be done by tandem manoeuvres. Clinical evaluation of gait should focus on the regularity of gait as a cyclic event. The fall risk status of an individual depends strongly on the number of the independent risk factors that one accumulates. Both prevention and therapy must focus on each of these individual risk factors. Preventing falls and its consequences is imperative for successful aging.

Accidental Falls↗

PubMed1997

Bilateral fracture dislocation of the sacroiliac joint.

We present a rare case of a 27-year-old man sustaining a bilateral fracture dislocation of the sacroiliac joints without disruption of the anterior pelvis, following a fall from a height. Reconstructed images in the coronal plane and three-dimensional CT images were invaluable in the diagnosis and assessment of this injury.

Accidental Falls↗

PubMed2005

Non-pharmacological means to prevent fractures among older adults.

Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long-standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a 'simple' fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high-impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called 'fall-induced high-impact injuries' instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal-trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury-site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone-specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor-assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury-site protection, padded strong-shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.

Accident Prevention↗

PubMed1996

[Prevention with hip protectors. Biomechanical aspects in falls and hip fractures].

The cascade of events leading to hip fracture is: a fall, protective responses, impact to the hip, local energy absorption and bone strength. A fall from standing height on the hip corresponds to a force of about 3500 N and the bone strength of the proximal femur in elderly women and men ranges between 2000 to 6000 N. Efficient hip protective systems have been developed and may be a significant factor in the prevention of hip fractures among the elderly with propensity to fall and osteoporosis. Theoretically, more than 90 per cent of all hip fractures can be prevented, and a substantial reduction in the rate of hip fractures can be obtained, when systematic intervention programs are initiated among nursing home residents. Prevention of hip fractures among home dwellers may be a greater challenge, although preliminary results seem promising. Improvement in design has made the protectors more compliant and may facilitate the aim of preventing hip fractures.

Accidental Falls↗

PubMed2005

Incidence and causes of maxillofacial skeletal injuries at the Mayo Hospital in Lahore, Pakistan.

Between January 2001 and December 2002, we studied a total of 702 patients with facial skeletal injuries, of whom 590 (84%) were male and 112 (16%) female. Injuries were most common (218 patients, 31%) in the third decade of life and there were 167 (24%) in the second decade. The most common cause was road traffic collisions (382 patients, 54%) and the second most common was a fall from a height (135 patients, 19%). The mandible was the most common bone to be fractured (473 patients, 67%) followed by the zygoma (209 patients, 30%). There were 199 patients with fractured maxillas (28%).

Accidental Falls↗

PubMed1999

[Compliance in use of external protectors for hip fractures among the community elderly in Japan].

To protect femoral neck fractures which are the most serious complication of osteoporosis and are increasing in frequency in Japan, an external hip protector (EHP) fixed in special underwear has been proven to absorb a direct impact to the greater trochanter during a fall from standing height. In this study, we investigated compliance concerning the use of EHPs, for six months using two types of EHP, i.e., hard pad type (Hip Protector, Sahvatex) from Denmark (Fig. 1) and soft pad type (Safety Pants, Rounomo Oy) from Finland. The subjects were 20 elderly women aged 70 years or more who had at least one experience of falling within the year preceding the baseline survey in September of 1997. The compliance rate is shown in Fig. 2. Though the soft type EHP had relatively better compliance than the hard type EHP, there was no significant difference between them. The main reason for early dropout (one or two weeks after base-line) was "difficulty to remove especially with regard to using the toilet". The main reason for later dropout was "too tight to wear in winter". There were no significant differences with regard to anthropometric measurements, physical activity, ADL, and rate of falls between compliers and dropouts except age (73.6 vs 78.5 yrs). Sufficient explanation at baseline and generatively good motivation for wearing the EHP will maintain a high compliance which may result in the effective prevention of hip fractures among the community elderly.

Aged↗

PubMedDate not supplied

[Evaluation of a safe rate when falling on one's head].

The authors analysed 303 patients with closed craniocerebral trauma resulting from falling from a height. The material obtained was treated by the methods of statistical analysis to reveal the relations of the severity of the craniocerebral trauma and the rate of the impact.

Accidental Falls↗

PubMed1993

Epinephrine stimulates Na-K pump by mediation of alpha-and beta-adrenoceptors in canine cardiac Purkinje fibers.

The effects of epinephrine on the twitch tension, intracellular Na+ activity (aiNa), and action potential were simultaneously investigated in an electrically driven canine Purkinje fiber. Epinephrine (0.3 microM) increased the twitch tension, duration of action potential (APD), and plateau height with a fall in aiNa. The twitch force increased during exposure and decreased during recovery. Propranolol (3 microM) or lidocaine (10 microM) decreased the twitch tension, APD, and aiNa when added to the bathing solution alone. They partially inhibited the effects of epinephrine (0.3 microM) on the development of the twitch tension and action potential and on the decrease of aiNa. Phentolamine (2 microM) reduced the twitch tension and plateau height of the action potential but failed to eliminate the action of epinephrine on the fibers. The combined action of phentolamine and epinephrine abbreviated the APD. The effect of epinephrine on the decrease of aiNa was entirely suppressed when the fiber was pretreated with propranolol (1 microM) and phentolamine (1 microM) or in a potassium-depleted solution. The results indicate that epinephrine exerts effects on the canine Purkinje fiber by the mediation of alpha-and beta-adrenoceptors. Adrenoceptor stimulation of both types is involved in the positive inotropic effect and the activation of the sarcolemmal Na-K pump.

Animals↗

PubMed1992

[Burst fractures of the cervical vertebrae].

A series of 237 patients with burst fracture of the cervical spine was treated between 1965 and 1991. These fractures usually result from head-on dive or fall from the height leading to quadriplegia. An early surgical decompression of the spinal cord and fusion of the spine at the site of injury from the anterior approach is the treatment of choice in author's opinion. It improves neurological and functional results of treatment, shortens hospitalisation time.

Accidental Falls↗

PubMed2005

[Pediatric head injuries: a retrospective analysis of 280 patients.].

BACKGROUND: To assess etiological factors, clinical features, radiological findings and recovery rates in pediatric head injuries. METHODS: Patients (n =280) with head injuries (age range: 0 - 16 years) hospitalized in Trakya University Department of Neurosurgery between January 1995 and 2004 were analyzed statistically. RESULTS: According to Glasgow Coma Scale (GCS) the patients had minor (GCS: 13- 15 ; 70.1% ), moderate (GCS: 9- 12; 17,1% ), or severe (GCS: 3 to 8; 6,8% ). head injuries The most common etiological factor was fall from a height (34,3%); and the most frequently associated injury was extra-spinal skeletal injury (12,9%). Fifty-one patients (18,2%) underwent neurosurgical operation. 87.5% of them recovered completely, while 12,5% showed partial recovery or died, as graded by Glasgow Outcome Scale (GOS). There was a moderately strong correlation between initial GCS and GOS (r=0,53, p=0,01). CONCLUSIONS: Nearly half of the pediatric head injuries were caused by falls with good prognoses. In the school age, motor vehicle accident (MVA) was the most frequent trauma type. MVA was the most serious type of trauma as demonstrated by its low GCS and GOS scores. Polytraumas, subdural hematomas, cerebral contusions, subarachnoid or intracerebral hemorrhages, cerebral edemas, diffuse axonal injuries, and any cranial lesion which required surgery were found to be related with poor prognosis.

Adolescent↗

PubMed2005

Delayed discovery of diaphragmatic injury after blunt trauma: report of three cases.

Blunt diaphragmatic injury is an increasingly common occurrence, frequently associated with considerable comorbidity. This injury is often missed at the time of the initial event, but may present some time later. We report three cases of diaphragmatic injury diagnosed 3 weeks, 6 months, and 12 years after the original diaphragmatic injury, respectively. Two of the injuries resulted from side-impact road traffic accidents and one followed a fall from a height. Gastrointestinal obstruction and respiratory compromise were the major presenting symptoms. All three patients were managed with a thoracotomy and the defect was closed without the need for prosthetic mesh. They all recovered uneventfully and have remained well since.

Accidental Falls↗

PubMedDate not supplied

Delayed presentation of unstable cervical spine injury with minimal symptoms.

Emergency physicians are less likely to suspect the presence of a severe or unstable cervical spine injury in patients who have been ambulatory since the traumatic episode. We present the case of a man with multiple cervical fractures and a 75% anterior subluxation of C6 and C7 who did not seek medical care for six weeks after falling from a height. Previous reports of delayed or occult cervical spine injuries are reviewed. Physicians must aggressively search for injuries whenever a history of neck pain is present or a strong mechanism of injury exists, even if the patient has been ambulatory for days or weeks following the injury.

Accidental Falls↗

PubMedDate not supplied

Gigantic post-traumatic pseudocyst of sigmoid mesentery.

A 29-year-old man presented with dull abdominal pain and a lump occupying almost the entire abdomen, four months after a fall from a height. Ultrasonography revealed a cystic lesion with debris occupying almost the entire abdomen. Diagnostic tap revealed brownish fluid. Exploration revealed a huge thick-walled cyst of the sigmoid mesocolon, which could be enucleated out entirely. Histology suggested it to be a false cyst.

Abdominal Injuries↗