|
|
| (4 intermediate revisions by one other user not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| [[File:Under Construction.jpg|thumb]] | | [[File:Midshaft-humerus-fracture.jpg|thumb|Transverse midshaft humeral fracture with medial displacement and anteromedial angulation of the distal fracture fragment. Minimal impaction.]] |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = {{PAGENAME}} | | | Name = {{PAGENAME}} | |
| Line 24: |
Line 24: |
| ==Overview== | | ==Overview== |
| {| class="wikitable" | | {| class="wikitable" |
| | ! |
| ! colspan="2" |The [[Humerus fracture]] are categorized as: | | ! colspan="2" |The [[Humerus fracture]] are categorized as: |
| |- | | |- |
| |A) Proximal humerus fracture: | | ![[File:Surgical-neck-of-humerus-fracture.jpg|thumb]] |
| |A) simple Proximal humerus fracture
| | ![[Proximal humerus fracture]] |
| B) comminuted Proximal humerus fracture
| | !simple Proximal humerus fracture |
| | comminuted Proximal humerus fracture |
| |- | | |- |
| |B) Mid-shaft humerus fracture: | | ![[File:Midshaft-humerus-fracture.jpg|thumb|318x318px]] |
| |Associated with the radial nerve injury
| | ![[Humeral shaft fracture]] |
| | !Associated with the radial nerve injury |
| |- | | |- |
| |C) Distal humerus fracture:
| | ! |
| |Uncommon injury in adults
| | ![[Distal humerus fracture]] |
| | !Uncommon injury in adults |
| More common in children | | More common in children |
| |} | | |} |
|
| |
|
| == For the detailed discussion regarding each type of humerus fracture please click on each type of fracture in above-mentioned table. == | | == For the detailed discussion regarding each type of humerus fractures please click on the name of fracture you need to study about. == |
| | | ==Related Chapters== |
| ==Historical Perspective==
| |
| In 1822, Sir Astley Cooper worked on the dislocations and Fracture of human body.
| |
| | |
| In 1934, Riccardo Galeazzi , an Italian surgeon at the Instituto de Rachitici in Milan, reported on his experience with 18 fractures with with close similarities to the Monteggia lesion.
| |
| | |
| In 1941, Campbell termed the Galeazzi fracture the "fracture of necessity".
| |
| | |
| In 1957, Hughston presented the definitive management of the Galeazzi fracture.
| |
| | |
| ==Causes==
| |
| The main etiology of the [[Humerus fracture]] is thought to be an axial loading may be placed on a hyperpronated forearm during falling onto an outstretched hand (FOOSH) with an extended wrist and hyperpronated forearm. Because at this posture the energy from the radius fracture transmitted towards the radioulnar joint cause the dislocation of the DRUJ.
| |
| | |
| == Pathophysiology ==
| |
| | |
| === Mechanism ===
| |
| The [[Humerus fracture]] is caused by a fall on the outstretched hands with the wrist in dorsiflexion position. The form and severity of this fracture depends on the position of the wrist at the moment of hitting the ground. The width of this mentioned angle affects the localization of the fracture. Pronation, supination and abduction positions leads the direction of the force and the compression of carpus and different appearances of injury.
| |
| | |
| === Pathophysiology ===
| |
| Its known that the [[Humerus fracture]] in normal healthy adults can be caused due to the high-energy trauma (e.g., motor vehicle accidents), sport related injuries, falling from height. But it should be noted that the most important Risk factors for insufficiency fractures is chronic metabolic disease such as steoporosis, osteopenia, eating-disordered behavior, higher age, prolonged corticosteroid usage, female gender, lower BMI, history of a recent falling, and prior fracture.
| |
| * The pattern of bone fracture and severity of injury depends on variety of factors such as:
| |
| ** Patients age
| |
| ** Patients Weight
| |
| ** Patients past medical history specifically any bone diseases affecting the quality of bone (such as osteoporosis, malignancies)
| |
| ** Energy of trauma
| |
| ** Bone quality
| |
| ** Position of the specific organ during the trauma
| |
| * The below-mentioned processes cause decreased bone mass density:
| |
| ** [[Autophagy]] is the mechanism through which [[Osteocyte|osteocytes]] evade [[oxidative stress]].
| |
| ** The capability of [[autophagy]] in cells decreases as they age, a major factor of [[Ageing|aging]].
| |
| ** As [[Osteocyte|osteocytes]] grow, viability of cells decrease thereby decreasing the bone mass density.
| |
| | |
| ==Differentiating Humerus fracture from other Diseases==
| |
| In the orthopedic medicine its important to know that the forearm fracture should be evaluated using radiography for both confirming diagnosis and also for evaluating the surrounding tissues. Other injuries such as possible olecranon fracture-dislocation; radial head or coronoid fractures or lateral collateral ligament injury, might be seen in Monteggia fracture. If the mechanism of injury suggests particularly low energy then the Osteoporosis should be considered. The pathological Fractures occurring in a bone with a tumor or Paget's disease) are rare but possible[3].
| |
| | |
| Also it should be noted that the both bone fractures can be complicated by acute compartment syndrome of the forearm. Signs suggesting compartment syndrome are pain on extension of digits, and marked edema[3].
| |
| | |
| As another important fact in orthopedic fracture is if both-bone fractures were found in pediatric which is common after accidental trauma, but it may also be the due to the of child abuse; and in these cases a careful attention and evaluation should be considered if a child abuse is suspected
| |
| | |
| ==Epidemiology and Demographics ==
| |
| | |
| ==Risk Factors==
| |
| There are different risk factors that presidpose patient for the Humerus fracture that include:
| |
| * High-risk contact sports
| |
| * Higher age (elderly adults are higher prone to such fractures)
| |
| * Reduced bone density (osteoporosis)
| |
| * Direct blow
| |
| * Road / traffic accidents
| |
| * Falling on an outstretched hand with the forearm pronated.
| |
| * Direct trauma to the arm/forearm
| |
| * Taking part in any rough or high-impact sport
| |
| * Street fights, gunshot wounds, and domestic violence, may also cause the Humerus fracture
| |
| * Road traffic accidents.
| |
| | |
| ==Screening==
| |
| Osteoporosis is an important risk factor for human affecting human bone especially in men with the age of older than 50 years old and [[postmenopausal]] and women.
| |
| | |
| Based on the [[US Preventive Services Task Force|US Preventive Services Task Force (USPSTF)]] there are three groups of patients need to be screened for the [[osteoporosis]]:
| |
| * · Men with no history of [[osteoporosis]]
| |
| * · Women with the age of 65≤ year old, with no previous history of pathological [[fracture]] due to the [[osteoporosis]]
| |
| * · Women with the age of <65 years, with 10-year [[fracture]] risk of not less than a 65-year-old white woman (who has not any other risk factor)
| |
| Accordingly women older than age of 50 are the main target for the [[osteoporosis]] screening. There is no specific recommendation to screen men for the [[osteoporosis]].<sup>[[Distal radius fracture screening#cite note-pmid21242341-1|[1]]]</sup>
| |
| | |
| The [[USPSTF]] recommendations from 2002 included:
| |
| | |
| Meanwhile, there are two major modalities for the [[osteoporosis]] screening:
| |
| # · [[Dual energy X-ray absorptiometry|Dual energy x-ray absorptiometry (DXA)]] of the [[hip]] and [[lumbar spine]] [[bones]]
| |
| # · Quantitative [[ultrasonography]] of the [[calcaneus]]
| |
| <nowiki>*</nowiki>It should be noted of the two above mentioned modalities for screening the ultrasonograhy is preferred to the DXA due to its lower cost, lower [[ionizing radiation]], more availability.
| |
| | |
| After the primary evaluation of the [[osteoporosis]], the further evaluation are required in some cases such as:
| |
| | |
| · Women with normal [[bone density]] or mild [[osteopenia]]: T-score of greater than −1.50 – should have screening for 15 years.
| |
| | |
| · Women with moderate [[osteopenia]]: T-score of −1.50 to −1.99 – should have screening for 5 years.
| |
| | |
| · Women with advanced [[osteopenia]]: T-score of −2.00 to −2.49 - should have screening for 1 year.
| |
| | |
| ==Natural History, Complications and Prognosis ==
| |
| | |
| === Natural History ===
| |
| In cases with untreated [[Humerus fracture]] the malunion and deformity of arm can be occurred.
| |
| | |
| === Complications ===
| |
| The overall complication rate in the treatment of [[Humerus fracture]] were found in around 40% of cases:
| |
| # Neurovascular compromise: such as Ulna nerve damage
| |
| # Compartment syndrome
| |
| # Chronic disability of the DRUJ
| |
| # Physeal Injury
| |
| # Malunion of the radius
| |
| # Nonunion
| |
| # Infection
| |
| # Refracture following plate removal
| |
| # Posterior interosseois nerve (PIN) injury.
| |
| # Instability of the DRUJ
| |
| | |
| === Prognosis ===
| |
| Successful treatment of [[Humerus fracture]] depends on the on-time interventions such as: reduction of the radius and DRUJ and the restoration of the forearm axis. The incidence of nonunion of [[Humerus fracture]] is very low. On the other hand, the rate of successful union following the open reduction of forearm fractures was reported around 98%. Previous researches showed that the loss of strength at the supination and pronation were found in 12.5% and 27.2%, respectively.
| |
| | |
| ==Diagnosis==
| |
| The diagnosis of a [[Humerus fracture]] should be confirmed using a radiographic examination.
| |
| | |
| Accordingly, the Walsh classification is based on the position of the radius:
| |
|
| |
|
| Type I
| | === [[Proximal humerus fracture]] === |
| * Dorsal displacement of the radius (Common type)
| |
| * Caused by supination force
| |
| Type II
| |
| * Volar displacement of the radius (Rare type)
| |
| * Caused by pronation force
| |
| The two main views such as anteroposterior (AP) and lateral forearm are needed in this regard:
| |
| * Radial shaft fracture:
| |
| *# Commonly found at the junction of the middle and distal third
| |
| *# Dorsal/Volar angulation
| |
|
| |
|
| * Radial shortening may occur
| | === [[Humeral shaft fracture]] === |
| * Dislocation of the distal radioulnar joint
| |
| Meanwhile, the following mentioned findings on the obtained radiography (such as plain radiography and the bilateral axial computed tomography (CT)) are suggestive of injury to the distal radioulnar joint (DRUJ):
| |
| * The dislocated radius near to the injury site
| |
| * Shortened radius by more than 5 mm near to the injury site
| |
| * The ulnar styloid base fracture near to the injury site
| |
| * Widening of the DRUJ space near to the injury site
| |
| | |
| ==History and Symptoms==
| |
| The related signs and symptoms include:
| |
| * Skin lacerations
| |
| * Weak pulse
| |
| * Open fractures
| |
| * Bruising
| |
| * Swelling
| |
| * Stiffness
| |
| * Inability to move
| |
| * Pain in touch
| |
| * Loss of function of the forearm
| |
| * Difficulties in detection of pulses
| |
| * Radial nerve damage
| |
| In the physical exam the orthopedic surgeon should check the vascular status and amount of swelling in the forearm. In MULTI-trauma patients or in comatose or obtunded patients a tense compartment with neurological signs or stretch pain should be considered as the [[compartment syndrome]], and the compartment pressures should be measured and monitored. Normally the pain and soft-tissue swelling are found at the injury site (distal-third radial fracture site and at the wrist joint). This injury should be confirmed using a radiographic evaluations. Also, patients may loss the pinch mechanism between their thumb and their index finger which can be due to the paralysis of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP).
| |
| | |
| ==Physical Examination==
| |
| The related signs and symptoms include:
| |
| * Edema of the forearm
| |
| ** Most of the time the edema will be a non-pitting edema
| |
| ** Depends on the edema extent, it may even lead to compartment syndrome in the anterior and internal compartment of forearm
| |
| * Bruising
| |
| ** As a manifestation of internal injury to the local vessels by trauma or fractures bone
| |
| * Decrease in range of motion
| |
| ** Movement of the fractures limb will be painful if possible at all
| |
| * Tenderness
| |
| * Deformity
| |
| ** Fractured bone deformity may be touchable in the internal side of the forearm if the fracture is displaced
| |
| In the physical exam the orthopedic surgeon should check the vascular status and amount of swelling in the forearm. In polytrauma patients or in comatose or obtunded patients a tense compartment with neurological signs or stretch pain should be considered as the [[compartment syndrome]], and the compartment pressures should be measured and monitored.
| |
| | |
| Physical examination of patients with [[Humerus fracture]] is usually remarkable for [[swelling]], [[tenderness]], [[Bruise|bruises]], [[ecchymosis]], [[deformity]] and restricted [[range of motion]] of the [[wrist]].
| |
| | |
| === Appearance of the Patient ===
| |
| * Patients with [[Humerus fracture]] usually appears normal unless the patients had a high energy trauma causing the open wound fracture.
| |
| | |
| === Vital Signs ===
| |
| * [[Pulse|Weak pulse]] may be seen when associated with [[polytrauma]].
| |
| * [[Hypotension|Low blood pressure]] with normal [[pulse pressure]] may be present due to [[compound fracture]] with [[Bleeding|blood loss]].
| |
| | |
| === Skin ===
| |
| * Skin examination of patients with [[Humerus fracture]] includes:
| |
| ** [[Bruise|Bruises]]
| |
| ** [[Ecchymosis]]
| |
| | |
| === HEENT ===
| |
| * HEENT examination of patients with [[Humerus fracture]]is usually normal.
| |
| | |
| === Neck ===
| |
| * Neck examination of patients with [[Humerus fracture]] is usually normal
| |
| | |
| === Lungs ===
| |
| * Pulmonary examination of patients with [[Humerus fracture]]is usually normal
| |
| | |
| === Heart ===
| |
| * Cardiovascular examination of patients with [[Humerus fracture]]is usually normal
| |
| | |
| === Abdomen ===
| |
| * Abdominal examination of patients with [[Humerus fracture]]is usually normal
| |
| | |
| === Back ===
| |
| * Back examination of patients with [[Humerus fracture]]is usually normal
| |
| | |
| === Genitourinary ===
| |
| * Genitourinary examination of patients with[[Humerus fracture]]is usually normal
| |
| | |
| === Neuromuscular ===
| |
| * Neuromuscular examination of patients with[[Humerus fracture]] is usually normal
| |
| * However, some patients may develop [[neuropraxia]] of the branch of the Ulnar nerve resulting in decreased sensation of thumb, index and middle finger.
| |
| | |
| ==Laboratory Findings==
| |
| There is a limited laboratory tests useful in the diagnosis of bone fractures such as the [[Humerus fracture]]. Meanwhile, aged men and women may have some abnormalities in their laboratory findings suggestive of osteoporosis.
| |
| | |
| Laboratory tests for the diagnosis of osteoporosis are:
| |
| * Complete blood count (CBC)
| |
| * Serum total calcium level
| |
| * Serum Ionized calcium level
| |
| * Serum phosphate level
| |
| * Serum alkaline phosphatase level
| |
| * Serum 25-(OH)-vitamin D level
| |
| | |
| ==X Ray==
| |
| The orthopedic surgeon should consider to have at least two radiographic projections (ie, anteroposterior [AP] and lateral) of the forearm. These show the fracture, the extent of displacement, and the extent of comminution. The orthopedic surgeon should pay serious attention toward finding any foreign bodies in open fractures and gunshot injuries. Also imperative is to include the elbow and wrist joint in the radiographs of [[Humerus fracture]] to ensure that the distal radioulnar joint injuries are not missed.
| |
| | |
| <gallery perrow="3">
| |
| File:Galeazzi-fracture-dislocation-3.jpg|Lateral- Type 1 Galeazzi fracture
| |
| | |
| </gallery>
| |
| | |
| ==CT ==
| |
| * CT-scan in the case of the [[Humerus fracture]]is the best modality if you can not have an exclusive diagnosis by X-ray itself can not be made.
| |
| | |
| ==MRI ==
| |
| * Magnetic resonance imaging (MRI) is an expensive technique that should not be used routinely.
| |
| * MRI is a powerful diagnostic tool to assess the abnormalities of the bone, ligaments and soft tissues associated with the [[Humerus fracture]], but it is known as a limited utility in radioulnar injuries and is not indicated in uncomplicated forearm fractures.
| |
| * Meanwhile, the MRI can be useful in in following mentioned evaluations:
| |
| * Evaluation of occult [[Bone fracture|fractures]]
| |
| * Evaluation of the post-traumatic or [[avascular necrosis]] of [[carpal bones]]
| |
| * Evaluation of [[tendons]]
| |
| * Evaluation of [[Median nerve|nerve]]
| |
| * Evaluation of [[carpal tunnel syndrome]]
| |
| | |
| ==Other Imaging Findings==
| |
| There are no other imaging findings associated with [[Humerus fracture]]
| |
| | |
| ==Other Diagnostic Studies==
| |
| There are no other Diagnostic studies associated with [[Humerus fracture]]
| |
| | |
| ==Treatment==
| |
| Immediate stabilization of patients is the first step. Then the radial fracture and the DRUJ stabilization is recommended in these cases. Open forearm fractures considered as a surgical emergency. [[Humerus fracture]] occurs in younger patients who are skeletally immature; the normally they treated using a closed reduction and casting. Since closed reduction and cast application have led to unsatisfactory results. Then, Almost always the open reduction are necessary for the [[Humerus fracture]]. There are controversies regarding the indications for intramedullary nailing of forearm fractures.
| |
| | |
| ==Non-Operative Treatmen==
| |
| * The first step in managing a patient with a fracture is to stabilize the patient if he/she is unstable due to blood loss, etc by giving them intravenous fluids and giving them some painkillers if the pain is severe.
| |
| * In children, the usual plan is to attempt closed reduction followed by cast immobilization. In adults, treatment with immobilization in a molded long arm cast can be used in those rare occasions of a non-displaced fracture of both bones of the forearm. If the fracture shifts in position, it may require surgery to put the bones back together.
| |
| | |
| * Rigid immobilization is suggested in preference to removable splints in nonoperative treatment for the management of the [[Humerus fracture]]
| |
| * For all patients with [[Humerus fracture]], a post-reduction true lateral [[Radiography|radiograph]] is suggested .
| |
| * Operative fixation is suggested in preference to [[Orthopedic cast|cast]] fixation for fractures with post-reduction radial [[shortening]] greater than 3 mm, dorsal tilt greater than 10º, or intra-articular displacement or step-off greater than 2 mm.
| |
| * Patients probably do not need to begin early wrist motion routinely after stable [[Bone fracture|fracture]] fixation.
| |
| * Adjuvant treatment of [[Humerus fracture]] with vitamin C is suggested for the prevention of disproportionate [[pain]]
| |
| | |
| <gallery perrow="3">
| |
| File:Monteggia-fractures.jpg|Combined Monteggia and Galeazzi fractures- Short arm backslab. Ulnar and radial midshaft fractures maintain similar alignment. Dorsally dislocated ulnar head (DRUJ). Volarly dislocated radial head (PRUJ) confirmed. Lat view
| |
| | |
| </gallery>
| |
| | |
| === Complications of Non-surgical therapy === | |
| Failure of non-surgical therapy is common:
| |
| * Re-displacement to its original position even in a cast
| |
| * [[Stiffness]]
| |
| * Post traumatic [[osteoarthritis]] leading to wrist pain and loss of function
| |
| * Other risks specific to cast treatment include:
| |
| ** Compression of the swollen arm causing [[compartment syndrome]] or [[carpal tunnel syndrome]]
| |
| ** [[Reflex sympathetic dystrophy]] is a serious complication
| |
| ** Stiffness is universal following a prolonged period of immobilization and swelling
| |
| | |
| ==Surgery==
| |
| Returning to the normal physical activity after [[Humerus fracture]]can take weeks to months of therapy under supervision an orthopedist. Meanwhile, a physiotherapy can be helpful for patient to achieve the normal wrist and elbow function caused by the immobilisation. All adult [[Humerus fracture]] should be considered to be treated with open reduction and internal fixation (ORIF).
| |
| | |
| <gallery perrow="3">
| |
| File:Galeazzi-fracture-dislocation-3 (4).jpg|PA- Type 1 Galeazzi fracture
| |
| </gallery>
| |
| | |
| | |
| === Operation ===
| |
| * There are a variety of methods and implants useful to stabilize the [[Humerus fracture]], ranging from closed reduction and percutaneous pin fixation to the use of intra-medullary devices.
| |
| * However, the most common fixation methods to treat complex [[Humerus fracture]] include [[external fixation]], and open reduction and internal fixation.
| |
| | |
| === External Fixation With or Without Percutaneous Pin Fixation ===
| |
| * [[Wrist]] spanning [[external fixation]] employs ligamentotaxis to restore and maintain length, alignment, and rotation of ulnar bone.
| |
| * Reduction is typically obtained through closed or minimally open methods and preserves the [[Bone fracture|fracture]] biology.
| |
| * The addition of percutaneous pins enhances the ability to reduce and stabilize fracture fragments.
| |
| | |
| ==== Complications of External Fixation ====
| |
| * Pin tract [[infection]]
| |
| * Injury to the [[Superficial branch of the radial nerve|superficial branch of the nerve]]
| |
| * [[Complex regional pain syndrome]]
| |
| | |
| === Open reduction and internal fixation with plates and screws ===
| |
| * This is the most common type of surgical repair for [[Humerus fracture]]
| |
| * During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment.
| |
| * The bones held together with special screws and metal plates attached to the outer surface of the bone.
| |
| | |
| | |
| | |
| ==== Complications of open reduction and internal fixation with plates and screws =====
| |
| * Infection
| |
| * Damage to nerves and blood vessels
| |
| * Synostosis
| |
| * Nonunion
| |
| | |
| === Pain Management ===
| |
| Pain after an injury or surgery is a natural part of the healing process.
| |
| | |
| Medications are often prescribed for short-term pain relief after surgery or an injurysuch as:
| |
| * opioids
| |
| * non-steroidal anti-inflammatory drugs (NSAIDs)
| |
| * local anesthetics
| |
| | |
| === Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive. It is important to use opioids only as directed by doctor. ===
| |
| | |
| === Interventions ===
| |
| The following options can be helpful for patients to rehabilitate after their fracture :
| |
| * Joints mobilization
| |
| * compression bandage
| |
| * Soft tissue massage
| |
| * Exercises and Activity modification
| |
| * Forearm taping
| |
| * Forearm bracing
| |
| | |
| == Postoperative Rehabilitation ==
| |
| * Complex [[Humerus fracture]] warrant individualized immobilization and rehabilitation strategies.
| |
| * Similarly, the addition of a thumb spica [[Orthopedic cast|cast]] or [[orthosis]] with positioning of the [[wrist]] in slight ulnar deviation for management of a [[comminuted]] radial column fracture may prevent loss of reduction. *Because most multifragmentary [[Humerus fracture]] are the result of high-energy injuries, a prolonged period of [[wrist]] immobilization and [[Soft tissue|soft-tissue]] rest may be beneficial and has not been shown to affect clinical outcomes.
| |
| * The [[wrist]] is typically immobilized for 2 weeks post-operatively in a sugar tong [[Splint (medicine)|splint]] with neutral forearm rotation.
| |
| * At 6 weeks post-operatively, the wrist is placed into a removable orthosis, and active and passive range of motion (ROM) is initiated.
| |
| * Full weight bearing commences at approximately 3 months post-operatively after consolidation of the [[Bone fracture|fracture]] is noted on radiographs.
| |
| * The presence of varying degrees of [[hand]], [[wrist]], and [[elbow]] [[stiffness]] is inevitable and may result from poor [[pain]] control, lack of effort in controlled mobilization, [[edema]], concomitant ipsilateral [[Upper limb|upper extremity]] [[Bone fracture|fracture]]<nowiki/>s, or [[Peripheral nervous system|peripheral nerve]] injuries.
| |
| * Early stretching and mobilization of the intrinsic and extrinsic [[Tendon|tendons]] of the [[hand]] is important to prevent finger [[stiffness]].
| |
| * [[Edema]] control can be initiated with compression gloves, digital massage, and active and passive ROM of the [[hand]].
| |
| * A home [[Physical exercise|exercise]] program or outpatient occupational therapy is started immediately post-operatively to maintain full [[range of motion]] of the [[hand]] and limit the development of intrinsic muscle tightness
| |
| | |
| ==Primary Prevention==
| |
| There are various preventive options to reduce the incidence of the [[Humerus fracture]]
| |
| # Using forearm and wrist guards during practicing sports (skating, biking)
| |
| # Using forearm and wrist guards during driving motorbikes
| |
| # Avoid falls in elderly individuals
| |
| # Prevention and/or treatment of osteoporosis
| |
| # Healthy diet
| |
| | |
| ==Secondary Prevention==
| |
| It should be noted that the Post-menopausal women specially older than the age of 65 are at the higher risk of [[osteoporosis]] consequently these type of patients at greater risk for the pathological [[Bone fracture|fractures]] .
| |
| | |
| So the [[Calcium]] and [[vitamin D]] supplementation play important role in increasing the [[Bone mineral density|bone mineral density (BMD]]) consequently decrease the risk of fracture in these type of patients. Also, avoiding excessive [[alcohol]] and quitting [[smoking]] play important role in this regard.
| |
| | |
| === Detecting osteoporosis===
| |
| * [[Dual energy X-ray absorptiometry|DEXA]](dual-energy x-ray absorptiometry) scan
| |
| * Serum [[calcium]] and [[vitamin D]] levels
| |
| * [[Medical ultrasonography|Ultrasonography]] of the [[calcaneus]]
| |
| | |
| === Pharmacological therapy ===
| |
| * The primary goal for the treatment of [[osteoporosis]] is to reduce longtime [[fracture]] risk in patients. Increasing [[Bone mineral density|bone mineral density (BMD)]] in response to the treatment is far less important than improvement of clinical aspects of [[osteoporosis]], i.e., [[Osteoporosis|osteoporotic]][[Bone fracture|fracture]]. Therefore, most of the [[drugs]] efficacy is measured by the extent they improve the [[fracture]] risk instead of increasing [[Bone mineral density|BMD]].
| |
| * During the treatment, if a single [[fracture]] happens, it does not necessarily indicate treatment failure or the need to be started on an alternative treatment or patient referral to a [[specialist]].
| |
| * [[Calcium]] and [[vitamin D]] supplementation have been found to be effective in reducing the long term [[Bone fracture|fracture]] risk, significantly. In order to suggest the people to use [[vitamin D]] and [[calcium]] [[supplements]], the [[physician]] needs to make sure that patient is not able to obtain the [[nutrients]] through the daily intake. The available supplemental ions of [[calcium]] include [[calcium carbonate]], [[Calcium citrate|calcium citrate,]] and [[vitamin D3]] in various [[Dosage form|dosage forms]].
| |
| | |
| === Life style modifications===
| |
| * [[Exercise]]: Exercise promotes the [[mineralization]] of [[bone]] and [[bone]] accumulation particularly during growth. High impact exercise, in particular, has been shown to prevent the development of [[osteoporosis]]. However, it can have a negative effect on bone [[mineralization]] in cases of poor [[nutrition]], such as [[anorexia nervosa]] and [[celiac disease]].
| |
| * [[Nutrition]]: A [[diet]] high in [[calcium]] and [[vitamin D]] prevents [[bone loss]]. Patients at risk for [[osteoporosis]], such as persons with chronic [[steroid]] use are generally treated with [[vitamin D]] and [[calcium]] supplementation. In [[Kidney|renal]] disease, more active forms of [[vitamin D]], such as 1,25-dihydroxycholecalciferol or [[calcitriol]] are used; as the kidney cannot adequately generate [[calcitriol]] from [[calcidiol]] (25-hydroxycholecalciferol), which is the storage form of [[vitamin D]].
| |
| * By quitting [[smoking]], [[osteoporosis]] as well as other diseases can be prevented.
| |
| * Avoiding excessive [[alcohol]] intake or drinking only in moderation (1–2 alcoholic beverages/day).
| |
| * Taking least possible dosages of certain medications that are associated with [[osteoporosis]] ([[anticonvulsants]] or [[corticosteroids]]).
| |
| | |
| ==References==
| |
| | |
| ==Related Chapters==
| |
| *[[Monteggia fracture]]
| |
|
| |
|
| | === [[Distal humerus fracture]] === |
| {{Fractures}} | | {{Fractures}} |
|
| |
| [[Category:Needs content]]
| |
| [[Category:Disease]]
| |
| [[Category:Orthopedics]]
| |
| [[Category:Radiology]]
| |
| [[Category:Primary care]]
| |
|
| |
|
| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| <references /> | | <references /> |
|
| |
|
| |
|
| |
|
|
| |
|
| Line 431: |
Line 77: |
| ==External links== | | ==External links== |
| * http://www.patient.co.uk/showdoc/40024961/ | | * http://www.patient.co.uk/showdoc/40024961/ |
| | {{WH}} |
| | {{WS}} |
|
| |
|
| | [[Category:Needs content]] |
| | [[Category:Disease]] |
| | [[Category:Orthopedics]] |
| | [[Category:Radiology]] |
| [[Category:Fractures]] | | [[Category:Fractures]] |
| {{WH}}
| |
| {{WS}}
| |
Humeral neck fracture Image courtesy of RadsWiki and copylefted
Humeral neck fracture Image courtesy of RadsWiki and copylefted
Humeral neck fracture Image courtesy of RadsWiki and copylefted
Humeral neck fracture Image courtesy of RadsWiki and copylefted
