Lower limb muscle strength and balance in older adults with a distal radius fracture: a systematic review

Impact of body composition on fragility fractures in US elderly adults: a population-based study

OBJECTIVES

The aim of this study was to investigate how variations in body composition impact the likelihood and location of fragility fractures in older adults.

METHODS

Data of US adults aged ≥ 60 years with fragility fracture and body dimension records (n = 13177, representing approximately 334 million US elderly adults) were from NHANES between 1999 and March 2020. We calculated body composition parameters, including the body roundness index (BRI), weight-adjusted waist index (WWI), abdominal visceral fat index (AVI), and arm-to-waist circumference ratio (AC/WC). Linear regression analyzed trends in site-specific fragility fractures, while logistic regression assessed the separate and joint effects of parameters.

RESULTS

Fragility fractures increased, especially among elderly with central obesity. A rounded body shape (OR4.42 ≤ BRI ≤ 5.60 = 0.6, 95% CI, 0.4-0.9; OR5.61 ≤ BRI ≤ 7.00 = 0.5, 95% CI, 0.3-0.8; ORBRI ≥7.01 = 0.4, 95% CI, 0.2-0.8) and a balanced arm-to-waist size (OR0.32 ≤ AC/WC ≤ 0.33 = 0.6, 95% CI, 0.4-0.9) reduced the risk of hip fractures, and a moderate fat content (OR11.45 cm/√kg ≤WWI≤1.93 cm/√kg = 0.6; 95% CI, 0.4-1.0) lowered the risk of vertebral fractures. Joint analyses found that moderate-built (ORBRI < 4.42, 10.96 cm/√kg ≤WWI≤11.44 cm/√kg = 1.9, 95% CI, 1.3-3.0) elderly faced doubled risk of hip fractures compared to those with severe central obesity (BRI ≥ 7.01, WWI 11.45-11.93 cm/√kg), while mild obesity (OR5.61≤ BRI≤7.00, WWI < 10.96 cm/√kg = 0.1, 95% CI, 0.0-0.6) carried only 10% of this risk. A stocky physique (ORBRI ≥ 7.01, AVI 20.48-23.44 cm²/1000 = 3.6, 95% CI, 1.1-11.1) was a significant risk factor for vertebral fragility fractures, while fit individuals with strong arms (ORBRI < 4.42, AC/WC ≥ 0.34 = 0.7, 95% CI, 0.5-1.0) experienced a lower incidence of vertebral fractures.

CONCLUSIONS

This population-based cohort study identified distinct risk groups for fragility fractures and clearly visualized these high-risk populations, which contributes to preventing fragility fractures and reduce the risk of second fractures.

A qualitative inquiry to explore management of distal radius fracture by certified hand therapists

BACKGROUND

Distal radius fractures (DRF) are extremely common in middle-aged and elderly. Certified Hand Therapists (CHT) are experts in managing hand injuries including DRF.

PURPOSE

Using qualitative methodology, this study examined practice patterns among CHT and understand prevalent common patterns in managing DRF.

STUDY DESIGN

Descriptive qualitative study.

METHODS

This study utilized a qualitative descriptive method with an inductive approach to discern the practices of CHT in managing DRF. A purposive sample of practicing CHT was assembled. A semi-structured interview guide facilitated qualitative interviews using open-ended questions to assess practices of CHT in the domains of assessment, interventions, and appropriateness for discharge. Two student physical therapists transcribed the interviews, which were verified by a third rater for accuracy. Thematic content analysis guided the coding and analyses of the interview data. A two-phase coding process was conducted using Nvivo software. Two study authors developed initial codebook and completed subsequent analysis of transcripts.

RESULTS

Of the 12 participants, five were PT and seven were OT with an average experience of 14.1 years as a CHT. Practice patterns across domains were largely consistent among CHT. All CHTs reported inquiring about severity of displacement of DRF, orthopedic management, comorbidities, and medical history as well as examining wrist/hand range of motion (ROM), grip strength (GS), and wrist functions (n = 12). A large majority administered outcome measures and performed sensory and integumentary assessment. Patient education regarding injury and exercises was the key element for interventions. Adequate gains in GS, wrist functions, wrist ROM, and ability to use wrist/hand for functional tasks were the key benchmarks for discharge from care.

DISCUSSION

Most practice behaviors were common among CHTs while managing DRF. Some variations exist depending whether their primary discipline is PT or OT. The results highlight knowledge-to-action gap, where most CHTs do not integrate fall-risk management in DRF.

CONCLUSIONS

This study identified common practice patterns among CHTs in managing DRF while also identifying opportunity to improve practice by integrating assessment of balance and fall-risk.

Distal Radius Fracture Rehabilitation

Distal radius fracture (DRF) is arguably the most common upper extremity fracture resulting from a fall accident. These clinical practice guidelines (CPG) were developed to guide all aspects of the management of DRF by physical therapists and other rehabilitation practitioners, such as certified hand therapists. This CPG employed a systematic review methodology to locate, appraise, and synthesize contemporary evidence while developing practice recommendations for determining the prognosis of outcomes, examination, and interventions while managing individuals with DRF. The quality of the primary studies found in the literature search was appraised using standardized tools. The strength of the available evidence for a particular practice domain (e.g., prognosis or intervention) was graded as strong, moderate, weak, or conflicting, where such gradings guided the level of obligation for each practice recommendation. Lastly, the CPG also provided the gaps in the evidence pool for the rehabilitation of DRF that future research efforts can address. J Orthop Sports Phys Ther 2024;54(9):CPG1-CPG78. doi:10.2519/jospt.2024.0301.

Decline in muscle strength and physical function after fracture in men - the prospective STRAMBO study

Studies on muscle strength and physical function after fracture are focused on short follow-ups and adjacent anatomical region. We compared loss of muscle strength and physical function in men after fracture with normal ageing-related decline. In 823 men aged 60-87, measurements of grip strength and clinical tests (chair stands, balance) were performed every 4 years for 12 years. In 155 men with incident fracture, we compared the status after vs. before the fracture. In men without fracture (controls), we compared the status on the first follow-up (4 years) vs. baseline. In men with fracture, grip strength decreased more than in the controls (41%, 0.28SD, P < .01). Men with fracture had higher risk of incident deterioration on the five chair-stand test vs. the controls (OR = 2.45, P < .001). They had higher risk of incident inability to stand for 10s with closed eyes vs. the controls (OR = 4.80, P < .01). They also had higher risk of deterioration on the tandem walk than the controls: forwards (OR = 2.04, P < .01), backwards (OR = 2.25, P < .005). The rapid physical decline was not limited to the region of the fracture site. In men who had incident non-upper limb fractures, grip strength decreased more (32%, P < .05) vs. the controls. In men who had incident non-lower limb fractures, the risk of decline in the tests of the lower limbs was higher vs. controls (chair stands, OR = 2.73, P < .001). The risk of decline was higher in men with clinical fractures which occurred >1 year before the next visit vs. controls (tandem walk forwards, OR = 2.98, P < .005). Overall, in older men, fractures were associated with greater loss of muscle strength and physical function vs. normal ageing. This accelerated decline was also found in the anatomical regions remote from the fracture site. Thus, programs to decrease or reverse the post-fracture decline could have beneficial effects on subsequent fracture risk.