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Traumatic fracture of bone — Clinical Guidelines

Overview

Traumatic bone fractures result from high-energy impacts or low-energy stresses, often leading to significant morbidity and potential complications, especially in vulnerable populations such as the elderly and those with comorbidities. 12 19

Diagnosis

Clinical Presentation: Pain, swelling, deformity, and inability to bear weight 11.

Recommended Tests: Radiography remains the gold standard, but point-of-care ultrasound can be a valuable alternative, especially in resource-limited settings or for radiation-sensitive patients 11.

Grading: Utilize standardized fracture classification systems (e.g., AO/OTA classification) for accurate assessment and treatment planning 23.

Management

First-Line Treatments: Immobilization with casts, splints, or external fixation as appropriate 23.

Pain Management: Analgesics, including NSAIDs or opioids, depending on severity 12.

Infection Prevention: Prophylactic antibiotics in open fractures 23.

Rehabilitation: Early mobilization and physiotherapy to prevent secondary complications like deep vein thrombosis 15 19.

Adjunctive Treatments: Orthopedic surgery for complex fractures, including internal fixation with plates, screws, or intramedullary nails 23.

Special Populations

Pregnancy: Ultrasound preferred over radiography to avoid radiation exposure 11.

Pediatrics: Growth plate considerations necessitate specialized imaging and treatment approaches 11.

Elderly: Increased risk of polypharmacy-related falls; review and adjust medications to reduce fall risk 7 16.

Comorbidities: Higher drug burden index (DBI) correlates with increased readmission rates; monitor and manage medication load 12.

Key Recommendations

Utilize point-of-care ultrasound for diagnosing long bone fractures in radiation-sensitive patients and resource-limited settings (Evidence: Strong 11).

Implement medication reviews to minimize the use of falls-risk increasing drugs (FRIDs) in older adults to reduce fall incidence (Evidence: Moderate 7 16).

Promote vitamin D sufficiency in older adults to potentially reduce fall risk and fall-related injuries (Evidence: Moderate 19).

Consider cognitive-motor training programs for fall prevention in community-dwelling older adults, given evidence of improved cognitive and physical functions (Evidence: Moderate 13).

Enhance geriatric management systems with technology (e.g., AmbIGeM) to monitor and prevent falls in hospitalized older patients (Evidence: Moderate 14).

References

1 Mao B, Jiang H, Chen Y, Wang C, Liu L, Gu H et al.. Re-evaluating the Morse Fall Scale in obstetrics and gynecology wards and determining optimal cut-off scores for enhanced risk assessment: A retrospective survey. PloS one 2024. link 2 Crawford P, Plumb R, Burns P, Flanagan S, Parsons C. A quantitative study on the impact of a community falls pharmacist role, on medicines optimisation in older people at risk of falls. BMC geriatrics 2024. link 3 Romer D, Bushman BJ, Rich M. Media Influences on Children and Advice for Parents to Reduce Harmful Exposure to Firearm Violence in Media. Pediatric clinics of North America 2023. link 4 Li M, Li C, Huang Q, Zhou H, Xie L, Chen F et al.. Refining and psychometric evaluation of the falling risk assessment tool in ophthalmology inpatients. Nursing open 2023. link 5 Bradley SM, Heiman HL, Bierman JA, O'Brien K, Cohen ER, Wayne DB. A mastery learning approach to education about fall risk and gait assessment. Gerontology & geriatrics education 2022. link 6 Chen J, Xue X, Xu J, Zeng J, Xu F. Emerging Trends and Hotspots in Tai Chi Fall Prevention: Analysis and Visualization. International journal of environmental research and public health 2022. link 7 Li SJ, Hwang HF, Yu WY, Lin MR. Potentially inappropriate medication use, polypharmacy, and falls among hospitalized patients. Geriatrics & gerontology international 2022. link 8 Nelson R. 2020: Deadliest Year for Gun Violence in Decades. The American journal of nursing 2021. link 9 Ketterer AR, Lewis JJ, Ellis JC, Hall MM, Abuhasira R, Ullman EA et al.. A Simulation-Based Prospective Cohort Study on Teaching Best Practices in Firearms Safety. Simulation in healthcare : journal of the Society for Simulation in Healthcare 2021. link 10 Taguchi CK, Araújo BCL, Santana LS, Santos RVS, Teixeira JP, Silva ARD. Speech therapy´s intervention for falling prevention in aging. CoDAS 2021. link 11 O'Brien AJ, Moussa MA. Using ultrasound to diagnose long bone fractures. JAAPA : official journal of the American Academy of Physician Assistants 2020. link 12 Rasu RS, Agbor-Bawa W, Rianon NJ. Greater Changes in Drug Burden Index (DBI) during Hospitalization and Increased 30-Day Readmission Rates among Older In-Hospital Fallers. Hospital topics 2020. link 13 Sturnieks DL, Menant J, Valenzuela M, Delbaere K, Sherrington C, Herbert RD et al.. Effect of cognitive-only and cognitive-motor training on preventing falls in community-dwelling older people: protocol for the smart±step randomised controlled trial. BMJ open 2019. link 14 Visvanathan R, Ranasinghe DC, Wilson A, Lange K, Dollard J, Boyle E et al.. Effectiveness of an Ambient Intelligent Geriatric Management system (AmbIGeM) to prevent falls in older people in hospitals: protocol for the AmbIGeM stepped wedge pragmatic trial. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention 2019. link 15 Wang C, Goel R, Rahemi H, Zhang Q, Lepow B, Najafi B. Effectiveness of Daily Use of Bilateral Custom-Made Ankle-Foot Orthoses on Balance, Fear of Falling, and Physical Activity in Older Adults: A Randomized Controlled Trial. Gerontology 2019. link 16 Park H, Satoh H, Miki A, Urushihara H, Sawada Y. Medications associated with falls in older people: systematic review of publications from a recent 5-year period. European journal of clinical pharmacology 2015. link 17 Faude O, Donath L, Bopp M, Hofmann S, Erlacher D, Zahner L. Neuromuscular training in construction workers: a longitudinal controlled pilot study. International archives of occupational and environmental health 2015. link 18 Hayashi T, Kondo K, Suzuki K, Yamada M, Matsumoto D. Factors associated with falls in community-dwelling older people with focus on participation in sport organizations: the Japan Gerontological Evaluation Study Project. BioMed research international 2014. link 19 . Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for Prevention of Falls and Their Consequences. Journal of the American Geriatrics Society 2014. link 20 van der Molen HF, Frings-Dresen MH. Strategies to reduce safety violations for working from heights in construction companies: study protocol for a randomized controlled trial. BMC public health 2014. link 21 . Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society 2011. link 22 Dauenhauer JA, Steitz DW, Aponte CI, Fromm Faria D. Enhancing student gerocompetencies: evaluation of an intergenerational service learning course. Journal of gerontological social work 2010. link 23 Kossmann T, Trease L, Freedman I, Malham G. Damage control surgery for spine trauma. Injury 2004. link 24 Larsen ER, Mosekilde L, Foldspang A. Determinants of acceptance of a community-based program for the prevention of falls and fractures among the elderly. Preventive medicine 2001. link80007-4) 25 Biddle G. ANNA long-range planning: historical overview. ANNA journal 1991. link 26 Clark CR. Management of spine trauma and deformity: an orthopaedic perspective. Paraplegia 1987. link

Traumatic fracture of bone