Fracture management in elderly people
- 1 month ago
Fracture management in elderly people
In this video SimpliHealth expert orthopedic doctor Dr. M.S Narula is talking about Fracture management in elderly people. Also, he is talking about
- When do fractures occur in older people?
- What are the problems, and how do we treat them?
As you know, our life expectancy is increasing with every passing year. So the population of older people is also growing, as the percentage of elderly people is rising, so we have to deal with old age-related problems. As an orthopedic surgeon, the most common and most challenging situation that comes into our practice is fractures in elderly people.
How are the bones in elderly people, and what are the challenges we face?
When we talk about their bone health, especially when they are 55 or 60 in women and after the age of 60-65 in men, their bones get osteoporotic. Our experts mean bones become more fragile by osteoporosis, and their bone mass reduces. Eventually, they become soft. Due to softness, the bones break off easily. Hence, they are more fragile at a certain age and more delicate, so there is always a fear of breakage. So whenever there is slight trauma or an accident like foot slips, there is a fracture, especially around the hips. As you must have heard often, there was a little foot slip and a fracture in the hip, fracture in the wrist or spine, so they have fragile bones which break off easily.
Second, what happens when we operate on them naturally because their healing power is low? As (our experts) said in the first lecture, how efficient bone connecting will depend on the healing power of nature and how robust their bones are. So, naturally, the healing process is slow in the case of weak bones. That’s why the fractures take more time to heal in elderly people, and their healing is slow.
Third, when we operate on them by putting any plate, screw, or nail, due to weak bones, there is always a fear that the nail or screw will back out. Like (our experts) give you an example, there is a wall, and (our experts) we put a nail on it. If that wall is hollow from behind or weak, it will come out whenever you hang something on that nail. So, in the same way, the bones are so soft that if we do surgery, there is always a fear that nails or plates will come out before healing in the bones.
The fourth challenge is that they always have one or another medical condition like a heart problem or sugar or a problem with blood pressure, making surgeries more challenging. Also, there are problems giving anesthesia to them. So there are a few challenges that we face in elderly people. But remember, our emphasis is on providing mobility to the old people who have fractures. So they should be able to stand or move on their own as soon as possible. Because if they keep lying in bed, their osteoporosis will get worse.
Do we need surgery for fractures in the elderly?
So in all our practices, our emphasis, especially on elderly people who have a fracture, is to make them stand up early and use their body parts. This could be possible with good surgery. Like (our experts) told you before, our primary emphasis is that fractures heal as early as possible. The second thing is we prefer to join limbs in the normal position. So that the patients are in a mobile state and use their limbs as early as possible, so for this, we like to operate on these fractures. Few fractures don’t require hairline treatment. However, we do provide them with plasters. But we try to operate in most cases since the healing rate is very low in elderly people. So in this, as (our experts) told you before, giving anaesthesia is one challenge, so we need to control BP and sugar as much as possible before any surgery.
TREATING FRACTURES IN ADULTS
It is a multidisciplinary approach for elderly people. We must operate on them where all the disciplines are available like a cardiologist must be on standby, a reasonable anesthesiologist, and one must have a nice ICU unit. Even God forbid, all these specialists should be at hand if there is any complication. So elderly people (our experts) will always insist that if they are going through any trauma fracture surgery or any other surgery, they should select a hospital with all the disciplines, especially a cardiologist and intensive care unit. So this is the first challenge that we should operate in an atmosphere that caters to all these specialties.
IMPLANTS USED FOR FRACTURES IN ELDERLY
Now we will talk about the implants. Now we have specialised orthopedic implants for trauma cases. As (our experts) told you before in a previous lecture, these are locking plates. If our bones are weak and we use standard plate screws, they will back out. So these days, we have special screws and plates for trauma and elderly people. These plates have a locking mechanism inside them, which locks the screw into the plate so that it doesn’t come out. So what happens with this? There are fewer chances of failure of implants. As (our experts) said, whenever there is a fracture, whether it’s in the spine or hip or hollow bone or bone with no strength in them. For this, we have artificial cement, which we put inside the bone and then implant or screw in the bone so that the hold of that implant increases.
Hip Fractures Among Older Adults
Then again, as (our experts) told us earlier, today we use nails. Like if there was a hip fracture earlier, then we put a plate, but nowadays, we have these specialised nails that we use, especially in hip fractures; there are long nails available. (our experts) emphasise this hip fracture because this is the most common fracture in elderly people. And if we don’t operate, the situation may worsen if left in bed for more than two months.
Why is opting for surgery important in older patients?
(our experts) always advise my patients, even if it has a bit of high risk, please opt for surgery. Because of this beauty, we can make the patient walk on the very next day, and it is possible only with these new implants. So these are unique nails that we insert by giving a small incision around the hip and locking it. The purpose of these nails is to make the patient able to stand the very next day. Also, we do small incisions. The use of nails in hip fractures, especially for elderly people, is one of the most significant advancements for orthopedic trauma.
And another thing (our experts) would say is that God has given us something that works like Stepney is a bone graft. So even in young people whose fracture is old, more than three weeks old, or in elderly people where we know the bones are less intense and fracture won’t last with plates or nails, we take a bone from where we tie our belt; there is one bone there called an iliac crest.
The procedure of bone graft
From the iliac crest, we take tiny slivers of bones and put them with the fracture along with nails and plate, which enhances the ability and speed of bones to join. So these are called bone grafts, and we use them when we anticipate a fracture that heals slowly. And at three months old, fractures, so the bone graft is the big savior in these situations. So there is some advancement in this field of bone graft. We have some artificial bones that we mix with the natural bones and put in the fracture.
So friends, as (our experts) told you, the management of fractures in elderly people is quite a challenge. Still, with the new techniques and implants and with the aid of a multidisciplinary approach, it is a very safe surgery. And wherever possible, we should opt for surgical options keeping all the risks in mind. But if the surgery is well done, with an experienced hand, we can give a new bone of life to the elderly people who need to be on their feet as early as possible. So stay safe, stay healthy.