Shabat S, Gepstein R, Mann G, Stern A, Nyska M
The Department of Orthopedic Surgery, The Sapir Medical Center, Kfar-Saba, and Tel-Aviv Sackler Medical School, Israel.
Disabil Rehabil. 2003 Aug 5;25(15):823-6. doi: 10.1080/09638280210142257.
The reasons for fractures in the elderly patients are multifactorial. Osteoporosis is considered to be the main pathology. Other reasons are the increase in fall frequency and the protective response to trauma. The most common sites at which these fractures occur are the hip, vertebra and distal radius. A combination of these is uncommon.
All patients who were treated between January 1990 and December 2000 with a combination of distal radius and hip fractures and were older than 65-years were retrospectively evaluated. The following parameters were evaluated: age; sex; pre fall function; use of drugs; chronic and acute comorbidity; circumstance of the fall; hospitalization length of stay; treatment procedure; complications; and post-hospitalization rehabilitation.
Forty-six patients met the study's criteria. Group I consisted of 16 patients between 65-80 years, and group II consisted of the remaining 30 patients older than 80 years. All patients suffered low energy trauma. Ten out of the 16 patients in group I, and eight out of the 30 patients in group II were totally independent, while the remaining patients needed some help with activity of daily living (ADL). In all patients the simultaneous fractures were ipsilaterally. For 45 patients hospital stay ranged from 5-23 days. Twenty-eight patients were transferred to a geriatric rehabilitation centre. Twenty-six of them returned to their previous ADL after a period of 60 days on average. Among the 18 remaining patients, 11 gained full recovery (6 from group I and 5 from group II) and seven patients (5 from group II) had a slight reduction in ADL.
A combination of these fractures is probably more traumatic and occurs in the higher-age group. It is always located in the ipsilateral side. The double trauma represents a better pre-morbid condition relative to patients in the same age group, and thus it may serve as a prognostic indicator for success in rehabilitation.
老年患者骨折的原因是多方面的。骨质疏松被认为是主要病理因素。其他原因包括跌倒频率增加以及对创伤的保护反应。这些骨折最常见的发生部位是髋部、脊椎和桡骨远端。这些部位同时发生骨折的情况并不常见。
对1990年1月至2000年12月期间接受治疗的年龄超过65岁的桡骨远端和髋部联合骨折患者进行回顾性评估。评估以下参数：年龄；性别；跌倒前功能；药物使用情况；慢性和急性合并症；跌倒情况；住院时间；治疗程序；并发症；以及出院后康复情况。
46例患者符合研究标准。第一组由16例年龄在65 - 80岁之间的患者组成，第二组由其余30例年龄超过80岁的患者组成。所有患者均遭受低能量创伤。第一组16例患者中有10例，第二组30例患者中有8例完全独立，其余患者在日常生活活动（ADL）方面需要一些帮助。所有患者的同时骨折均发生在同侧。45例患者的住院时间为5 - 23天。28例患者被转至老年康复中心。其中26例患者平均在60天后恢复到之前的ADL水平。在其余18例患者中，11例完全康复（第一组6例，第二组5例），7例患者（第二组5例）的ADL略有下降。
这些骨折的联合可能更具创伤性，且发生在高龄组。骨折总是位于同侧。相对于同年龄组的患者，双重创伤代表了较好的病前状况，因此它可作为康复成功的预后指标。
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