Spontaneous fractures in nursing home residents

TC Wong, WC Wu, HS Cheng, YC Cheng, SK Yam
Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong

OBJECTIVES. To evaluate spontaneous long bone fractures occurring in nursing home residents and to identify what factors put them at risk for fractures.

DESIGN. Retrospective study.

SETTING. Department of Orthopaedics and Traumatology of a pubic hospital in Hong Kong.

PATIENTS. A total of 30 nursing home residents who developed spontaneous long bone fractures between 1994 and 2005 were reviewed.

MAIN OUTCOME MEASURES. Demographic data, mechanism of injury, pattern of fractures, associated risk factors, complications, outcomes, and post-treatment status.

RESULTS. The mean age of patients was 84 years. Co-morbidities were as follows: 22 patients were bedridden, 21 required long-term feeding by Ryle's tube, 19 had a history of cerebrovascular accident and 18 of whom had a long bone fracture on the side of the hemiplegia, 15 had dementia, and 25 had lower limb contractures. Closed supracondylar fractures of the femur occurred in 23 patients, 17 of whom presented with limb deformity. In 21 patients, fractures were treated successfully with hinged braces. In one patient, the fracture changed from closed to open. In five patients, the fractures were complicated by sacrum or heel sores, and in one by infected nonunion. In 28 patients, the fractures eventually healed without further complications. Three formerly bedridden patients were able to sit after their fractures had been treated.

CONCLUSIONS. Female nursing home residents who require long-term Ryle's tube feeding, have dementia, hemiplegia, lower limb contractures, osteoporosis, or are bedridden, are at high risk for spontaneous fractures.

Hong Kong Med J 2007;13:427-9

Key words: Femoral fractures; Fractures, spontaneous; Nursing homes; Risk factors