Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 44  |  Issue : 2  |  Page : 90-94

Pattern of fractures among patients with musculoskeletal injuries due to fall: A Hospital-based study from North India


1 Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India
2 Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India

Date of Web Publication11-Oct-2017

Correspondence Address:
Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_4_17

Rights and Permissions
  Abstract 

Background: Falls are a major cause a cause of unintentional injury. Reports in past suggest that majority of falls happen from fall from one level to another followed by fall from trees. In the year 2004, 17.2 million Daly's have been reported to be loss of due to falls. The study was planned with the aim to assess the pattern of fractures due to fall. Materials and Methods: The study was conducted as a hospital-based descriptive study conducted for 1 year between June 2014 and May 2015 using a record-based registration system at a tertiary care center in a rural area of Northwest India. The study population comprised all consecutive cases of musculoskeletal injuries due to fall reporting to the tertiary care center during the study except for those who denied consent to be included in the study. Results: It is seen that fracture distal end radius was the most common, followed by fracture both bone forearm and supracondylar fracture of elbow in the upper limb. Further, it is seen that intertrochanteric fracture and fracture both bone leg are the most common fractures in the right lower limb. Conclusions: Most often the cause of fall is multifactorial, even though it is know that falls are non-inevitable, therefore preventive strategies have much importance to avoid the fall related injuries.

Keywords: Fall, fractures, musculoskeletal injuries, pattern


How to cite this article:
Awasthi B, Raina SK, Singh U, Thakur L, Kalia S. Pattern of fractures among patients with musculoskeletal injuries due to fall: A Hospital-based study from North India. J Sci Soc 2017;44:90-4

How to cite this URL:
Awasthi B, Raina SK, Singh U, Thakur L, Kalia S. Pattern of fractures among patients with musculoskeletal injuries due to fall: A Hospital-based study from North India. J Sci Soc [serial online] 2017 [cited 2020 Sep 18];44:90-4. Available from: http://www.jscisociety.com/text.asp?2017/44/2/90/216501


  Introduction Top


Falls are second only to road traffic injuries as a cause of unintentional injury. Reports in past suggest that majority of falls happen from fall from one level to another followed by fall from trees. In the year 2004, 17.2 million Daly's have been reported to be loss of due to falls.[1]

As the population ages, the problems related to falls and fractures are expected to grow and pose an even greater challenge to the health care systems. Meeting these ever growing challenges requires a clear understanding of the prevalence and nature of falls, innovative planning to develop prevention programs, systems and structures which will support falls prevention initiatives, and substantial reforms and policies at the local and national levels. Most often the cause of fall is multifactorial, even though it is know that falls are noninevitable, therefore preventive strategies have much importance to avoid the fall related injuries.[1] Earlier we reported on the pattern of extremity fractures among patients with musculoskeletal injuries.[2]


  Materials and Methods Top


The study was conducted at a tertiary care center in a rural area of Northwest India. The study was conducted as a hospital-based descriptive study conducted for 1 year between June 2014 andMay 2015 using a record-based registration system. The study population comprised all consecutive cases of musculoskeletal injuries due to fall reporting to the tertiary care center during the study except for those who denied consent to be included in the study.

The selected participants were registered and administered on a questionnaire on sociodemographic profile which included details on age, sex, occupation, economic status, and types of family. After completing the sociodemographic questionnaire, we elicited the history of the patient, which included mode of injury, place of injury, and type of injury. Once the history was completed further clinical examination was performed which included vitals of the patients, head to toe examination followed by radiological examination (X-ray, computed tomography, magnetic resonance imaging, and ultrasonography) and required blood investigations. If the patient was brought disoriented, an attempt was made to collect the information from the patient's attendant. In case of a minor (<18 years of age) reporting with musculoskeletal injuries, a detailed history on injury was corroborated by conducting a simultaneous interview with parent/guardian of the minor. All the information collected was entered in a register specially maintained for the purpose of recording the data on musculoskeletal injuries due to fall.

Statistical analysis

A database of all registered patients was maintained and entered into MS Excel 2007. The statistical analysis was done using Statistical Package for Social Sciences Version 17.0 (Statistical Product and Service Solution SPSS inc., IBM Armonk, New York, USA) and result had been expressed using percentage. Statistical significance was assessed with the help of Chi-square test and P < 0.05 was taken as statistically significant.


  Results Top


[Table 1] shows the distribution of nature of injury with types of fall. It is observed that out of 795 patients with fall, fractures (n = 566/795, 71.1%) are the most common injuries reporting to tertiary care center. The association of types of fall with nature of injury was found to be statistically significant (P< 0.05). [Table 2] provides details on the distribution of fractures in upper right limb with types of fall. It is seen that fracture distal end radius (n = 57/160, 35.6%) was the most common, followed by fracture both bone forearm (n = 24/160, 15.0%) and supracondylar fracture (n = 20/160, 12.5%) of elbow. Further, it is observed that fall while walking (n = 38/57, 66.6%) was the most common mode for distal end radius fractures, while in fracture both bone most common mode was fall from height (n = 10/24, 41.6%). The association of types of fall with fractures of the right upper limb was found to be statistically significant (P< 0.05). [Table 3] provides details on distribution of fractures in left upper limb with types of fall. It is seen that fracture distal end radius was the most common fracture (n = 67/165, 40.1%) followed by fracture both bone forearm (n = 21/165, 12.7%) and supracondylar fracture (n = 13/165, 7.8%). It is also observed that fall during walking was the most common mode of injury for distal end radius fracture (n = 39/67, 58.2%) and fall from stairs was most common for fracture both bone forearm (n = 7/21, 30.0%), while fall during playing was the most common mode of injury for supracondylar fracture (n = 7/13, 53.8%). The association of types of fall with fractures of left upper limb was found to be statistically significant (P< 0.05). [Table 4] shows the distribution of fracture right lower limb with types of fall. It is seen that intertrochanteric fracture (n = 19/116, 16.4%) and fracture both bone leg (n = 17/116, 14.6%) are the most common fractures in right lower limb. Along with isolated tibia fractures 5 (0.6), fracture both bone was the most common (n = 22/116, 18.9%) fracture. Further, it is observed that fall from height was the most common mode for fracture both bone leg (n = 7/17, 41.1%), while fall during walking was the most common mode for intertrochanteric fractures (n = 9/19, 47.3%). The association of types of fall with fractures of the right lower limb was found to be statistically not significant (P > 0.05). [Table 5] provides details on the distribution of fracture left lower limb with types of fall. It is seen that fracture both bone leg (n = 18/106, 16.9%), intertrochanteric fracture (n = 16/106, 15.1%), and fracture metatarsal foot (n = 17/106, 16.0%) were the common fractures in right lower limb. It is also observed that fall from height was the most common mode for fracture both bone leg (n = 8/18, 44.4%), while fall during walking was the commonest mode for intertrochanteric fractures (n = 12/16, 75.0%). The association of types of fall with fractures of left lower limb was found to be statistically significant (P< 0.05).
Table 1: Distribution of types of injuries with types of fall

Click here to view
Table 2: Distribution of right upper limb fracture with types of fall

Click here to view
Table 3: Distribution of left upper limb fracture with types of fall

Click here to view
Table 4: Distribution of right lower limb fracture with types of fall

Click here to view
Table 5: Distribution of left lower limb fracture with types of fall

Click here to view



  Discussion Top


Various study done in different places observed that in older age group hip fractures were common injuries due to fall and in children fracture both bones were the commonest fracture due to fall while playing.[3],[4],[5],[6] A study done in Saudi Arabia observed that upper limb fractures are more prevalent than lower limb fracture and in which radius was most common bone.[7] A study done in West Nigeria observed that anterior dislocation shoulder was the most common dislocation followed by elbow dislocation.[8]

In the present study, fracture distal end radius in right upper limb and in left upper limb was most common in young and elderly population due to fall during walking, as patients use their forearm and hand to prevent fall events.[9] While in children <15 year fracture both bone right side and left side forearm followed by supracondylar fracture was common on right side and left side, which occurred mostly while playing.

In lower limb fracture intertrochanteric right and left femur in elderly, which occurs due to fall while walking and fracture both bone leg right leg and left leg in adult is most common injury, for which fall from height was a common mode of injury. In dislocation, most common was dislocation shoulder followed by elbow due to fall while walking and least common is hip dislocation.


  Conclusions Top


Most of the times the cause of fall is multifactorial, even though it is thought that falls are non-inevitable. Therefore preventive strategies have much importance to avoid the fall related injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Celine TM, Antony J, Johnson A. A retrospective study on fall related injuries at a tertiary care level. Saudi J Health Sci 2013;2:137-41.  Back to cited text no. 1
    
2.
Awasthi B, Raina SK, Negi N, Sharma V, Kalia S, Thakur L. Pattern of extremity fractures among patients with musculoskeletal injuries - A hospital based study from north India. J Med Soc 2016;30:35-7.  Back to cited text no. 2
  [Full text]  
3.
Cumming RG. Epidemiology of medication related falls and fractures among the elderly. Drugs Aging 1998;12:43-53.  Back to cited text no. 3
[PUBMED]    
4.
Yoshida S. Epidemiology of Falls, a Global Report on fall Prevention. Ageing and Life Course, Family and Community Health. World Health Organization. Available from: http://www.who.int/ageing/project/1.epidemiology%20of%falls%20in%20older%20age.pdf. [Last accessed on 2016 Jul 10].  Back to cited text no. 4
    
5.
Gururaj G. Injuries in India: A National Perspective. NCMH Background Papers-Burden of Disease in India. Available from: http://www.nimhans.kar.nic.in/epidemiology/doc/ep_ff23.pdf. [Last accessed on 2016 Jul 10].  Back to cited text no. 5
    
6.
Falls and Hip Fractures: Factsheet. National Center for Injury Prevention and Control. Available from: http://www.cdc.gov/ncipc/factsheets/falls.htm. [Last accessed on 2016 Jul 10].   Back to cited text no. 6
    
7.
Shaheen MA, Madr AA, Al-Kbudary N, Kham FA, Mosalem A, Sabet N. Pattern of accidental fractures and dislocations in Saudi Arabia. Injury 1990;21:347-50.  Back to cited text no. 7
    
8.
Ebong WW. The pattern of fractures and dislocations in West Nigeria. Injury 1978;3:221-4.  Back to cited text no. 8
    
9.
Meena RK, Singh AM, Singh CA, Chisthi S, Kumar AG, Langshon R. Pattern of fractures and dislocations in a tertiary hospital in North East India. Int J Epidemiol 2013;11:13-5.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
References
Article Tables

 Article Access Statistics
    Viewed1444    
    Printed62    
    Emailed0    
    PDF Downloaded164    
    Comments [Add]    

Recommend this journal