Epidemiology of fractures during COVID-19 pandemic: a short review

Summary Introduction and purpose: The purpose od this study is to describe changes in epidemiological trends of fractures, especially osteoporotic fractures, during COVID-19 pandemic. Before the pandemic, fractures in the young population were more frequent than in elderly population, because of more active lifestyle. A brief description of the state of knowledge: COVID-19 pandemic and lockdown has effectively reduced people’s mobility and ability to travel. This has resulted in lowered rate of traumatogenic incidents that cause fractures, including traffic accidents and accidents during performing sport. When people spend more time at their homes, incidence of household fractures is growing, especially in elderly population. Osteoporosis makes bones of elderly people more suspectible to fracture. Majority of drugs used in treatmen for osteoporosis are said not to interact with risk or severity of COVID-19 infection. Conclusions: During the COVID-19 pandemic, geriatric fractures have become one of the severe problems for healthcare systems. Isolation at people’s homes has resulted in increased rate of fractures occuring at home, especially in elderly population. Difficulties caused by pandemic made rates of properly performed osteoporotic treatment lower, increasing risk of fractures even more. Mortality after fractures has risen even in patients with negative result of testing for COVID-19.

Are Locked Plates Necessary to Maintain Reduction in the Treatment of Geriatric Ankle Fractures?

Category: Ankle; Trauma Introduction/Purpose: Treatment of geriatric fractures are unique in their perioperative and postsurgical complications. Increased age, increased number of comorbidities, and decreased bone quality present a significant challenge when treating geriatric fractures, including ankle fractures. Recent studies have hypothesized using locking plates will lead to better outcomes compared to non-locking plates in geriatric ankle fractures. Conventional non-locking plates depend on the bone quality and screw-plate friction in order to achieve proper fixation and stability whereas locking plates do not. Locking plates are common in this patient population due to greater rigidity and biomechanical stability while not relying on bone quality to maintain fixation. This study aims to determine if locking plates are necessary to maintain reduction in geriatric ankle fractures. Methods: After approval from the Institutional Review Board, a retrospective chart review was performed on all patients 60 years or older sustaining an ankle fracture between 2012-2018. Patients with less than 3 months follow-up at the time of injury were excluded. Each patient underwent surgical fixation at the discretion of the attending surgeon for bimalleolar or trimalleolar ankle fractures. The following patient information was collected from the charts: age, mechanism of injury, and comorbidities. Radiographic review was performed to determine open or closed fracture status, the type of fracture pattern and presence or absence of a syndesmotic injury. Patient radiographs from the most recent follow-up were analyzed for maintenance of reduction and use of a locking or non-locking plate. Statistical analysis was performed using the Chi Square Test for significance and the Fisher’s Exact Test when necessary. Results: Out of 218 patients, 143 received locking plates (L) and 75 received non-locking plates (NL). There were 99 bimalleolar fractures (69.2%) and 44 trimalleolar fractures (30.8%) in the L group. The NL group had a higher percentage of trimalleolar fractures, 50.7% (38), with 37 bimalleolar fractures (49.3%) (p=0.004). The two groups did not differ in terms of mechanism of injury (p=0.906), high energy (39.2% in L and 41.3% in NL, p=0.773), and open fractures (24.5% in L and 17.3% in NL, p=0.227). Upon radiographic review, 142 patients in the L group (0.7%) and 72 patients in the NL group (4.0%) maintained reduction (p=0.119). Loss of reduction in the L group was a trimalleolar fracture whereas 2 bimalleolar and 1 trimalleolar fractures in the NL group. Conclusion: Our study demonstrates that there is not a greater loss of reduction when utilizing locking plates. Surgeons should keep this in mind when choosing constructs for fixation of geriatric ankle fractures.

Fraktur geriatrik

Elderly have higher risk for fractures due to aging process which causes decreased bone density and quality. Inferior trunk fractures are the most common fractures in the elderly group, namely fractures of the hip, pelvis, lower vertebrae, and ankle. Geriatric fractures can be caused by high and low impact mechanisms. Low impact fractures most often occur due to osteoporosis associated with a mechanism of fall. Changes in musculoskeletal system are decreased muscle mass as well as bone density and quality that lead to osteoporosis. The diagnosis of fracture is based on history, physical examination, and supporting investigations. Treatment of geriatric fractures needs to be carried out by a team of doctors consisting of orthopedic doctors and geriatric doctors. Good communication and appropriate therapy plans need to be prepared thoroughly to achieve proper treatment in handling geriatric patients, therefore, the quality of life can be improved and disabilities can be prevented.Keywords: geriatric fracture Abstrak: Kelompok lanjut usia (lansia) memiliki risiko tinggi untuk terjadinya fraktur akibat proses penuaan yang menyebabkan penurunan kepadatan dan kualitas tulang. Fraktur trunkus inferior merupakan fraktur paling umum pada kelompok lansia yaitu fraktur pinggul, panggul, vertebra bagian bawah, dan pergelangan kaki. Fraktur geriatrik dapat disebabkan oleh mekanisme high impact maupun low impact. Fraktur low impact paling sering terjadi disebabkan oleh karena keadaan osteoporosis disertai dengan mekanisme jatuh. Perubahan yang dapat terjadi pada muskuloskeletal yaitu penurunan massa otot serta penurunan kepadatan dan kualitas tulang yang menyebabkan terjadinya osteoporosis. Diagnosis fraktur ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang. Penanganan fraktur pada lansia perlu dilakukan oleh tim dokter yang terdiri dari dokter ortopedik dan dokter geriatrik. Komunikasi yang baik dan rencana terapi yang tepat perlu dipersiapkan agar pasien lansia dapat ditangani dengan baik sehingga dapat memperbaiki quality of life dan mencegah disabilitas.Kata kunci: fraktur geriatrik