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Jun 2026 DOI 10.14302/issn.2474-7785.jarh-26-6358
Marks RayCorresponding author
Hip fractures, which remain an immense public health concern, have been subject to study and prevention efforts for many decades, but with limited success in averting either incident, second or subsequent hip fractures, commonly attributed to a combination of age related proclivity to fall, low bone and muscle mass. This review examines second hip fracture incidence rates and determinants of this serious functionally debilitating injury as observed over time remains a current 2026 public health concern. It specifically explores if more preventive efforts are currently warranted in this regard, and in what respect, if indeed, more frail older adults are living longer, but may be in excessively poor health, fearful of moving or falling, malnourished, weak with poor balance, or depressed. Based on what is published, it is concluded 1) second hip fracture incidence rates remain considerable, especially among those who are frail with osteoporotic bone disease, poor vision, heart/or cognitive conditions, plus those with muscle deficits of the lower limb, live alone and have a falls history; 2) studies to identify possible mitigation approaches appear promising in this regard, along with more routine efforts to minimize falls risk and bone attrition.
Aug 2020 DOI 10.14302/issn.2474-7785.jarh-20-3495
Marks RayCorresponding author
Department of Health and Behavior Studies, Teachers College, Columbia University, NY 10027, United States
Hip fractures, which remain highly prevalent among the elderly and produce enormous social and economic costs, have not truly abated in prevalence despite years of research that outlines a multitude of preventable risk factors and intervention programs. This review aimed to examine if sleep disturbances have a bearing on the risk of incurring a hip fracture directly or indirectly, among older adults. The specific aim was to explore and summarize what we know, and how this might inform future research and practice. To this end, PUBMED, Web of Science, Scopus, and Google Scholar data bases were searched to uncover available data representing the topic of sleep in relation to hip fractures among the elderly. Articles of note were scrutinized and summarized in narrative form. Results showed very few studies on the topic prevail, even with no restriction on years examined, and of these, discordant, rather than any solid uniform conclusions prevail. It is concluded there is a need to explore this topic carefully, including both the direct, as well as the indirect impact of sleep that may place an older adult at heightened risk for a fall and hip fracture injury as well as subsequent fractures.
Apr 2019 DOI 10.14302/issn.2688-5328.ijp-19-2717
Ip DavidCorresponding author
FRCS FHKCOS FHKCOS (Rehabilitation) FHKAM (Ortho Surg), Wellness Pain Centre Hong Kong
Objective The current clinical case series assess the clinical outcome of the use of low-level laser in the treatment of painful pediatric fractures not solidly consolidated and re-modelled after casting for a standard of 4-6 weeks Materials and Methods The patient cohort consisted of 17 consecutive unselected patients in pediatric age group with delayed fracture consolidation and/or undesirable angulation despite casting for a standard period of 4-6 weeks in whom the parents refused any surgical intervention and/or bone grafting options. All subjects were referred from other medical centers after inadequate healing of the fracture ends upon repeating the x ray after the cast was off at the 4-6 weeks mark. Low-level laser therapy (LLLT) on alternate days for 8weeks in upper limb fracture cases, and 12 weeks in lower limb fracture cases were administered with a view of enhancing bone healing and/or re-modelling since both previous clinical and basic science studies on LLLT showed a stimulatory effect on fracture healing. Results All patients had solid union, mean time for union for upper and lower limb fractures were 6 and 10 weeks respectively. The calculated p value is statistically significant at p < 0.05. No patient defaulted follow up. All parents were satisfied with the clinical and radiological result of the LLLT treatment. Conclusion LLLT was found not only to enhance bone healing potential but in fact improved bone re-modelling when used in the proper wavelength and energy density in pediatric upper and lower limbs fractures, thereby also rapidly resolve the intolerable pain in paediatric fracture population
Feb 2018 DOI 10.14302/issn.2766-6204.jmpt-17-1913
NF TepeneuCorresponding author
Department of Pediatric and Adolescent Surgery, General Hospital Klagenfurt, Austria
The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50–70%), lateral condylar (17–34%), and medial epicondylar fractures (10%). The mechanism of injury varies, but the most commonly described mechanism involves a fall on an outstretched hand with varus, valgus or rotational force or a combination thereof. The vectors of force and the degree of chondro-osseous development dictate the type of injury incurred. A review of the literature was conducted to see the most frequent injuries and complications.
Aug 2020 DOI 10.14302/issn.2474-7785.jarh-20-3496
Marks RayCorresponding author
Department of Health and Behavior Studies, Teachers College, Columbia University, NY 10027, United States
Osteoarthritis, a widespread joint disease, commonly results in considerable pain and functional disability, especially among older adults. At the same time, falls and fall injuries, also common among the older population, may not only contribute to the onset of osteoarthritis, but once established, to falls that lead to fractures and disability in their own right. But what does the research show specifically? Objective This report aimed to examine what is known about the interrelationship between falls and osteoarthritis and the implications that can be drawn from this information. Methods Using the PUBMED data base, studies describing an association between osteoarthritis and falls were sought. Those fulfilling the eligibility criteria were reviewed and summarized in narrative form. Results Consistent support for an osteoarthritis-falls associated linkage is limited and not as robust as one would predict. Whether the observed associations between these health determinants are a cause of osteoarthritis, a consequence or both, or simply spurious findings is hard to decipher. Conclusion More numerous and carefully designed research to examine this issue is warranted and may be extremely helpful in preventing, as well as ameliorating a high degree of excess disability and associated fiscal costs due to both falls as well as osteoarthritis among the elderly.
Jun 2019 DOI 10.14302/issn.2474-3585.jpmc-19-2750
Konadu-Yeboah DominicCorresponding author
Orthopaedic and Trauma Surgeon, Komfo Anokye Teaching Hospital, Kumasi, Ghana, Part-Time Lecturer, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Purpose Foot injuries are common in low- and middle-income countries and continue to increase in incidence due to the surge in the use of motorcycles as means of transport.Yet, there is scanty data on the incidence and outcomes of treatment of open injuries to the foot in the developing world.We aimed to determine the incidence and functional outcomes of open foot injuries that are treated in a teaching hospital in Ghana. Methods We used a structured questionnaire to record the type of open foot injury, the mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the hospital for treatment as well as the type of treatment instituted. Recruited patients were followed up for six months, complications resulting from the injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using a questionnaire-based visual analogue outcome scale of the American Foot and Ankle Society. Regression and chi-square analysis were used to evaluate potential associations. Results Over a four-month period, a total of 81 cases of open injuries to the foot were recorded. Out of this figure, 55 patients (67.9%) were males and 26 (32.1%) were females. It was found, that 66.7% aged between 19 and 49 years, 76.5% of the injuries occurred on the road and 29.7% was motor cycle related. Pedestrians are the most afflicted (61.7%). The treatment outcomes of traumatic amputations, open phalangeal fractures, dorsal skin degloving and lacerations were good. Gustillo-Anderson grade IIIB open fractures with associated plantar skin degloving had the worst outcomes with residual pain on weight bearing, bigger foot, inability to wear previous shoes and inability to tiptoe on the affected foot. Conclusions Open injuries to the foot are common in Ghana and exert a significant health burden, particularly on active young males. Long term disability may occur, even after adequate treatment of open fractures involving the foot.
Apr 2018 DOI 10.14302/issn.2577-2279.ijha-18-2030
A. Kiryanov N.Corresponding author
Izhevsk State Medical Academy, Russia.
Introduction: The use of non-medicinal facilities for correcting processes in various pathological conditions is one of the most urgent problems of modern medicine. Purpose of the Work: To study the effect of low-intensity infrared laser radiation on reparative bone formation and angiogenesis in bone regeneration which is formed in treatment of fractures under conditions of transosseous osteosynthesis. Material and Methods: A tibia fracture was modeled experimentally in rats in the control and experimental groups. Reposition and fixation of fragments were performed. The fracture zone in the experimental group animals was exposed to the impact of pulsed infrared laser irradiation of low intensity. Animals from the control group underwent the impact simulation. The operated bones were investigated using the methods of X-ray, light and electron microscopy, X-ray electron probe microanalysis. Results: It was established that laser radiation exposure sessions activated fibrillogenesis and angiogenesis, accelerated compacting of newly formed bone tissue and increased its maturity while primary fracture healing occurred. Prolonged capillary dilatation and endothelium-dependent vasodilation, intensive capillarogenesis were noted after sessions of laser therapy in bone regeneration. Endothelial outgrowth was formed in the lumen of the vessels forming capillary buds that propagate along the “mother” vessels (endovascular capillarogenesis). Conclusion: The data obtained revealed a possible mechanism of laser radiation exposure at the level of a whole organism and proved the effectiveness of its application in clinical practice at the early stages of patient rehabilitation under conditions of transosseous osteosynthesis.
Sep 2017 DOI 10.14302/issn.2474-7785.jarh-17-1724
Wanby PärCorresponding author
Section of Endocrinology, Department of Internal Medicine, Kalmar County Hospital, Kalmar, Sweden
Hypovitaminosis D is common among older people and treatment with vitamin D is associated with reduced risk of falls and fractures. This paper provides a cost analysis of assessing the vitamin D status of and providing the pharmaceuticals for elderly citizens in Kalmar County, Sweden (population approximately 230,000). Four hypothetical interventions were analyzed: (a) systematic vitamin D/calcium supplementation to all elderly (≥75 years), (b) assessment of vitamin D status in elderly and supplementation to those with insufficient levels, (c) systematic vitamin D/calcium supplementation to all nursing-home residents, and (d) assessment of vitamin D status in nursing-home residents and supplementation to those with insufficient levels. The calculations were based on an estimated reduction in overall costs due to the assessed number of hip fractures after vitamin D/calcium supplementation. The annual net economic benefit of vitamin D/calcium supplementation was estimated at (a) €304,000, (b) €860,000, (c) €755,000, and (d) €740,000. The provision of systematic vitamin D supplementation to nursing-home residents would provide a substantial net economic benefit to society and assessment of the vitamin D status before starting supplementation does not seem to be necessary. Although assessment of all elderly citizens would be more comprehensive, the true proportion with insufficient vitamin D levels in the general population is uncertain and to reaching consensus on the most advantageous daily vitamin D intake, vitamin D blood levels are necessary. Also, systematic supplementation to all elderly would result in other outcomes that could be worth the cost, but that remains to be evaluated.
Jun 2017 DOI 10.14302/issn.2473-1005.jdoi-16-1193
Mugisha Rwenyonyi CharlesCorresponding author
Department of Dentistry, College of Health Sciences, Makerere University, Kampala
The objective of the study was to establish the role of helmet use on severity and pattern of maxillofacial injuries among motorcycle crash victims attending Mulago Hospital. This was descriptive cross sectional case series study using a questionnaire in form of an oral interview, clinical examination and review of medical records of the patients. The pattern of injuries was assessed based on the demarcated regions of the face. The severities of the injuries were scored using the Facial Injury Severity Scale. The data were analysed using SPSS version 17.0. There were 105 participants (male/female: 97/8) aged 15 to 63 years. Most participants (n= 74, 70.5%) were riders and the rest were passengers. There were no female riders. Most participants were from Kampala and surrounding districts. Overall, 35.2% of the participants had helmets: 50% of the riders and 0% of the passengers. About 73% o the participants used Three Quarter Shell helmet design. There was no significant difference in the pattern of injuries between the passengers and non helmeted riders (p=0.076). There was a higher frequency helmeted riders (n = 15, 40.5%) with pan-facial fractures compared to other participants. Non helmeted riders and passengers had significantly more injuries to the lower two thirds of the face compared to the helmeted riders. Passengers had less severe facial injuries compared to riders. We conclude that about a third of the participants who were riders used helmets, being particularly the Three Quarter Shell design. The helmeted riders had more severe maxillofacial injuries and of panfacial category as compared to other participants. The passengers had least severe injuries compared to riders. It is recommended to carry out further studies to elucidate on motorcycle related maxillofacial injuries especially in regard to the quality of helmets and their adequate use.
Apr 2017 DOI 10.14302/issn.2474-7785.jarh-17-1483
Dorfman JonCorresponding author
Department of Surgery, University of Massachusetts Memorial Medical Center Worcester, MA
Background: Discharge disposition planning begins at admission and is frequently one of the first questions posed to healthcare providers by patients and families. We hypothesized that pre-injury functional status would predict discharge disposition. Methods: We linked prospective data from the Worcester, MA cohort of the Global Longitudinal Study of Osteoporosis (GLOW) study and the UMassMemorial Level 1 Trauma Center Registry to determine predictors of discharge disposition for female geriatric (over the age of 55) trauma patients using bivariate comparisons and multivariable modeling. Results: 154 women of 5,091 in the Worcester GLOW cohort were evaluated for traumatic injury at UMassMemorial and were discharged alive either to their home (n=30) or to rehabilitation, skilled nursing, or nursing home facilities (n=124). The mean age was 79 years and the majority (99%) was white. There were no statistically significant differences in comorbidities or injury severity score between the groups. All women with femur fractures were discharged to a facility. The most common injury among women discharged home was traumatic brain injury. While univariate analysis revealed differences in pre-injury activity status, only age remained statistically different in a logistic regression model predicting discharge to facility (OR 2.61 per additional 10 years of age, 95% CI 1.62 to 4.19, p<0.0001). Conclusions: The majority of elderly women are not discharged home after injury. Pre-injury activity status was not associated with discharge disposition when accounting for other factors. It appears that physical function, which deteriorates with age, is a proxy for aging in older women at risk for osteoporosis.