THE HIP FRACTURE IS AN INJURY AND A DISEASE AT THESAME TIME
Abstract
BACKGROUND Low bone mineral density (BMD) can not accurately differentiate between those who willexperience a hip fracture and those who will not after the fall from standing high. Itinfluences the predicted success of future fracture prevention in less than 50 %. Bone strengthexplains the ratio between applied force that act to deform the bone in the counter and thereduced ability of osteoporotic bone to resist some more than the physiologic load in thedenominator. The Nevitt’s bone fragility factor explains a hip fracture at the same time asan accident (counter) and a disease (denominator).The dominant factor in a hip fracture is the fall of the elderly patient. Falls are not onlyaccidents, but are also a consequence of the normal aging process. Falls are preventable bythe multifactorial interdisciplinary prevention program (MIPP). Unfortunately as muchas 75 % of women and 90 % of men at high risk in nursing homes are not investigated, and75 % of those affected are not treated. CONCLUSIONS Very useful is Charlson’s comorbidity index with 19 typical geriatric diseases, predictingdeath in hospitalized elderly with fragility fracture (heart, lung, kidneys, vessels, DM,tumor, liver, dementia, coagulopathies). If the patient has not any comorbidity, his oneyear mortality is estimated to be 12 %. With 1–2 comorbidities estimated mortality is 26 %,with 3–4 comorbidities 52 %, with 5 or more comorbidities the mortality is above 85 %. Inhip fracture Charlson index is on average 3.4. All comorbidities benefit from early operation and early mobilizationDownloads
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