elderly hand fractures singapore 2015 rauma conference v2.0
TRANSCRIPT
Hand and Wrist Fractures
in The Elderly
Mr Vaikunthan Rajaratnam Senior Consultant Hand Surgeon
This work is licensed under a Creative Commons Attribution 4.0 International License.
I heard the old, old men say,“Everything alters
And one by one we drop away”.They had hands like claws, and their knees
Were twisted like the old thorn treesBy the waters
W B Yeats
Ageing Hand
age-related degenerative changes in the• musculoskeletal,• vascular, and • nervous systems. • a combination of local structural changes (joints, muscle,
tendon, bone, nerve and receptors, blood supply, skin, and fingernails) and more distant changes in neural control.
• accompanied by underlying pathological conditions (osteoporosis, osteoarthritis, rheumatic arthritis, and Parkinson's disease)
J Gerontol A Biol Sci Med Sci. 2003 Feb;58(2):146-52.The aging hand.
Carmeli E, Patish H, Coleman R.
Effects of aging on hand function.PARTICIPANTS:• Healthy, independent, young (n = 27, range 20-35 years) and older (n
= 28, range 65-79 years) subjects.• The decrease in the ability to maintain steady submaximal pinch
force was more pronounced in women than men.CONCLUSION:• Aging has a degenerative effect on hand function, including declines
in hand and finger strength and ability to control submaximal pinch force and maintain a steady precision pinch posture, manual speed, and hand sensation.
J Am Geriatr Soc. 2001 Nov;49(11):1478-84, Ranganathan VK, Siemionow V, Sahgal V, Yue GH, Cleveland
Effects of aging on adult hand function.
study was conducted examining relationships between prehension pattern type and frequency, hand strength, and performance time in functional tasks.
Four groups of 10 adults were selected by age and gender, ranging from 24 to 87 years. Subjects were asked to pour milk into a cup and remove money from a wallet while being videotaped. Statistically significant differences in age1. prehension pattern frequency,2. hand strength, 3. and performance time. Hand function seemed to remain stable until age 65 years, . After age 75 years, age differences in performance were most apparent.
Shiffman LM.Am J Occup Ther. 1992 Sep;46(9):785-92
The effects of strength training on finger strength and hand dexterity in healthy elderly individuals
strength training-improve finger strength. improve the hand function of less healthy elderly subjects.
Journal of Applied Physiology October 2008 vol. 105 no. 4 1166-1178
Halla B. Olafsdottir, et al,
• N = 585• Age 16 and
above• 2 groups >60 and
<60• N=34 vs n=551
THE EPIDEMIOLOGY AND DISTRIBUTION OF HAND FRACTURES IN SINGAPORE
Jin Xi Lim, Jia Jun Justin Boey, Jun Hao Tan, Alvin Chin Kwong Tan,Rajaratnam Vaikunthan
1 Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
2 National University of Singapore, Singapore
Gender
Female Male0
10
20
30
40
50
60
70
80
90
100
11
89
5644
<60 >/= 60
Perc
enta
ge
Location/ circumstance of injury
Home Public Place Work RTA Assault/ Fight Sports Not recorded0
10
20
30
40
50
60
70
80
9 8
51
19
2 7 4
71
312
60 0
9
<60 >/= 60
Perc
enta
ge
Mechanism of Injury
Amputation
Axial L
oadCru
sh
Direct
impact
Hyper-e
xtensio
n
Flexio
nSh
arp
Not reco
rded
0
10
20
30
40
50
60
3 3
38
8 5 19
33
0 3
21
315
0 3
52
<60 >/= 60
Perc
enta
ge
No of Fractures
1 2 3 4 60
10
20
30
40
50
60
70
80
90
100
73
167 3 1
94
6 0 0 0
<60 >/= 60
Perc
enta
ge
Open/ Closed injury
Closed Open0
10
20
30
40
50
60
70
80
90
61
39
77
23
<60>/=60
Perc
enta
ge
Fracture distribution
<60 years old >/= 60 years old
DEMOGRAPHICS 40 cases
• GENDER Male: 17 ( 41.4% )Female: 23 ( 58.6% )
• AGE
Oldest: 101Youngest: 60Mean: 70.275
• RACE
Chinese: 28Malay: 3Indian: 9
• GAINFUL EMPLOYMENT Yes: 4No: 36
Gender
MaleFemale
Race
ChineseMalayIndian
Mean 73.60
Median 73.00
DOMINANT HAND INJURY
• HANDEDNESSRight: 29Left: 0Unknown: 11
• HAND INJURED
Dominant: 17Non-Dominant: 12Unknown: 11
Hand Injured
DominantNon-Dom-inantUnknown
GENESIS OF INJURY• LOCATION INJURY SUSTAINED
Home/ Nursing Home: 25Workplace: 4 (all those gainfully employed)Public Place: 5Others: 6
• MECHANISM OF INJURY
Crush Injury: 8Penentrating/Sharp Injury: 1Blunt Trauma : 1Hyperextension: 5Fall/Axial Load: 1Others/Unknown: 24
Crush
Injury
Blunt trau
ma
Fall/
Axial lo
ad0
5
10
15
20
25
30
Mechanism
Mechanism
Location
Home/Nurs-ing HomeWorkplacePublic PlaceOthers
FRACTURE PATTERNS• NUMBER OF FRACTURES
Single: 38Multiple : 2 ( both 2 each )
• FINGER INVOLVED
Thumb: 5Index: 4Middle: 3Ring: 6Little: 16Unknown: 6
• TYPE OF FRACTUREOpen: 8Closed: 30Unknown: 2
ThumbIndex
Middle
RingLitt
le
Unknown
0
4
8
12
16
Finger
Finger
Type of FractureOpen ClosedUn-known
MANAGEMENT
• Operative: 3 2 Plate & Screws 1 Interfragmentary screw
• Conservative: 37
# Metacarpal Base with extension to Shaft
5th Metacarpal Neck #
# Shaft of 5th Metacarpal
P1 Base # ring finger
P1 Base # ring finger – Post op
P1 Head intra-articular #
Tuft #s
Thumb P1 Base intra-articular #
• 12% had a superficial infection (all treated with transverse pinning with wires left exposed);
• 39% had some impairment in skin sensation; 29% reported cold intolerance; and
• 10% had other complications.
Surgical intervention - only when one is sure of giving better results than conservative management
My view
• Treat as with all patients – implant evolution• Discuss options and outcomes• Manage physiological age not chronological• Pre existing symptomatic OA – consider fusion
and replacement• Manage osteoporosis• High demand elderly ?
Thank you