Archive for the ‘Fracture’ Category
Usually we operate on a Hip Fracture. We do that in order to: preserve Independent Living; or preserve independent ambulation in Assisted Living; or preserve assisted ambulation in a Care Facility; and always to preserve quality of life. But what if none of those goals are possible?
At the St Paul Geriatric Fracture Conference this month, it was proposed that alternative care to surgery is sometimes more humane and less costly to society – both laudable goals. The ideal care for a patient with a fractured hip is to thoroughly discuss all alternatives before proceeding to surgery.
Family and other caregivers should all join the patient for a relaxed discussion of the future, weighing quality of life issues radically changed by the usual loss of function / independence imposed by the fracture. Only after concensus is reached, should surgery proceed – if that is the chosen path.
Unfortunately, the clock is ticking. The likelihood of death, medical complications of the fracture, medical complications of surgery, and permanent disabilities begin to increase only 12 hours after fracture. Gathering all interested parties and making informed life-changing decisions within that time limit is very challenging.
Ideally the patient, family, care-givers and primary physician have discussed the possibility of fracture and come to tentative decisions about what sorts of care are desired. This is especially true for patients who already cannot ambulate, are becoming demented, or have a limited quality of life.
Involve the patient in the decision while he/she can still express his/her desires. Written Advanced Directives are ideally on file with physician and hospital. Allow the patient to Take Control of his/her Future.
My wife and I have discussed our desires with our children. We have advanced directives on file. You should too.
Jay Ginther, MD
Sometimes a person breaks a hip first, then they fall. This happens a lot more often than we realize. When the break is just below the ball of the hip, the fracture may have come before the fall. Moreover, that Fragility Fracture may have gradually developed over days or weeks.
How is it possible that a person does not realize that the hip is gradually crumbling? We call it a Stress Fracture when a crack gradually developes. Small cracks gradually getting bigger are usually not recognized until they are completely across the bone and it breaks, causing the patient to fall. Why?
The aching pain of a stress fracture is often too gradual to distinguish from arthritis pain until the break is complete and the whole bone collapses. The best way to see this process is to watch a video of the I-35W bridge collapsing in Minneapolis on 1st August 2007. http://search.yahoo.com/search?ei=utf-8&fr=aaplw&p=i35w+collapse Tiny cracks slowly developed in the steel until one day……..THUD!
How can you detect who is at high Hip Fracture Risk? A very low DXA T-score, especially in the spine, is a good indication. But DXA often fails if the spine is already crumbling or has arthritis. A better indication is Vertebral Fracture Assessment (VFA). Looking at the spine from the side, Vertebral Compression Deformities can indicate crumbling spongy bone in the spine before the spongy bone in the hip also crumbles.
Know where you stand. Get a Complete Bone Health Evaluation. Take Control of your future.
Jay Ginther, MD
Fractures are NOT FUN. Not something you want to repeat. Any fracture is a Bone Attack. It is a warning that you probably have Bone Health issues that can be improved. Get a Complete Bone Health Evaluation and work to prevent a second fracture. Most people can succeed in preventing that second fracture.
I see many individuals who have had a first fracture. Often the DXA, BMD, and T-score are not that bad. I even see many who have good DXA test scores. But they still fractured with relatively minor trauma. They proved that they have increased Fracture Risk. Why?
24% of men over 50 will suffer a fracture due to Clinical Osteoporosis. More than 3/4 of them will have a DXA score of “osteopenia” or “normal”. DXA is not the whole story.
This is a graphic of those lucky men who will not fracture (O), and those men who will fracture (X) without treatment for their bone health:
OOOXOOOOXOOOXOXOOXOOOOOXOOOXOOXXOOOXOOOOXOOO OXOOOOXOOOXOOOOXOOOXOXOOOXOOOOXOOOXOOOXOOOOX OOXOOOXOOOOXOOOXOOOOXOOOXOOOOXOOOXOOOOXOOOXO XOOOXOOOOXOOOXOOOOOXOOOXOOXOOOOXOOOXOOOOXOOX OOOXOOOOXOOXOOOXOOOXOOOOXOOOXOOOXOOOOOXOOXOO XOOOXOOXOOOOXOOOXOOOOXOOOOXOOOXOOOXOOXOOOXOO OXOOOXOOOXOOOXOOOXOOXOOOXOOOXOOOXOOOXOOOXOOO OOOXXOOOXOOOXOOXOOOOOXOOOOXOOXOOOOXXOOOXOOOO OXOOOXOOOOXOOOXOOOXOOOOXOOOOXOOOXOOOOXXOOOOX XOOOXOOXOOOXOOOOXOOOXOOOOXOOOXOOOXOOOXOOOXOO OXOOOXOOOXOOOXOOOXOOOXOOOXOOOOXOOOXOXOOOOOOX OOXOOOXOOOXOXOOOXOOOXOOOXOOOXOOOXOOOXOOOXOOO OXOOOXOOOXOOOXOOOXOOXOOXOOOOXOOOOOXOOOXOOOXO OOXOOOOXOOOXOOOXOOOXOOXOOOXOOOXOXOOOXOOOXOOO XOOOXOOOXOOOXOOOOXOOOXOOOXOOOXOOOXOOOXOOOOOX OOOXOOOXOOOXOOOXOOOXOOOXOOOXOOOXOOOXOOOXOOXO OXOOXOOOOXOOOXOOOXOOOXOOOXOOOXOOOXOOOOXOOOOX OOOXOOOOXOOXOOXOOOXOOOOXOOOXOOOOXOOOXOOOOXOO XOOOOXOOOXOOOXOOOXOOOXOOOXOOOXOOOOOXOOOXOOOX XOOOOOXOOOOXOOOXXOOOXOOXOOOXOOOXOOOOOXOOOXOO OXOOXOOOOXOOOOXOOOXOOXOOOOXOOOXOOOXOOOXXOOOO OOXOOOXOOOXOOOXOOOOXOOOXOOOOXOOOXOOOXOOOXOXO XOOOOXOOOXOOOXOOOXOOOOXOOOOXOOOOOXOXOOOXOOOO OOXXOOOXOOOXOOOOOXOOOXOOOXOOXOOOXOOOOOXOOOOX XOOOOXOOXOOOXOOOOOOX
Fractures are not fun! This could be You. We can prevent over 2/3 of those fractures with treatment. Get a Complete Bone Health Evaluation to know your Fracture Risk.
Then Take Action to Prevent Fractures!
Jay Ginther, MD