You’ve Got a Fracture: Now What?

PJ Hamel Health Guide
  • You knew you were suffering bone loss, and you did what you could to stop it. But despite all your efforts, you’ve broken your wrist. Or been diagnosed with a vertebral fracture. Or, worse – you’ve fractured your hip. What will your treatment be like? And what can you do afterwards to recover?

    There are about 1.5 million osteoporosis-related fractures reported each year in the United States. Perhaps surprisingly, the most common cause of these fractures is a simple fall from standing height: slipping on loose carpet, stepping off a curb, or simply losing your balance.

    Other fractures occur as the result of even simpler causes: spinal fractures, for instance, can happen just by twisting or bending the wrong way. Or you might fracture small bones in your feet by stepping on something while walking.

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    There are three main types of bone fractures commonly associated with osteoporosis: wrist, spine, and hip. Let’s look at them one by one.

    Wrist/forearm fracture: This is the most common type of osteoporosis fracture in men and women in their 50s and 60s. In fact, a wrist fracture due to “minimal trauma” – a minor fall or accident, something that doesn’t seem like it should have done much damage – is often what leads to an osteoporosis diagnosis.

    Thankfully, wrist fractures are the least serious, the least life-impacting, and the most easily treated of the osteoporotic fractures. A simple fracture is one where the bone has broken, but the pieces are close enough together that the doctor can simply move them back to their original position manually, then apply a cast. A complex fracture, which involves the wrist joint itself, or more than two pieces of bone, may need to be set surgically before being immobilized.

    You’ll be in a cast for at least 6 to 8 weeks. It might extend just to your elbow, or might include your elbow, as well. At any rate, you’ll need short-term help with everyday tasks (getting dressed, cooking, etc.), until you figure out the work-arounds that make sense for you.

    Physical therapy to regain use of your hand and wrist can start soon after you’ve had the bone(s) set. A therapist will show you exercises – some passive, some active – for your hand, wrist, elbow, and shoulder, all of which can be affected by this type of fracture.

    If you do the exercises regularly, as suggested, you have a much better chance of a normal recovery. Stiff fingers are a common after-effect of wrist fracture; considering how much you use your fingers, play special attention to any hand exercises your PT suggests.

    Spinal fracture: Vertebral compression fractures (VCF) are the most common type of fracture due to osteoporosis. In fact, they outnumber hip and wrist fractures combined. And only about 1/3 of them are diagnosed; they’re truly a “silent fracture.”

    How can so many spinal fractures go undiagnosed? Well, for one, a spinal fracture can be painless; its only symptom might be stooped posture, or a slight loss of height the doctor notes at your annual physical. More noticeably, the “widow’s hump” that older women sometimes develop is due to repeated spinal fractures that eventually affect the vertebrae.

  • In addition, the pain sometimes caused by spinal fractures can be the result of so many other issues (arthritis, for instance), many people simply attribute back pain to old age, and live with it.

    If you’re in severe back pain, and are diagnosed with a spinal fracture, you have several treatment options.

    •Non-surgical treatment. This might include physical therapy, bed rest, cortisone injections, and perhaps a back brace.
    •Vertebroplasty and kyphoplasty. These are both surgeries performed under local anesthetic. The doctor injects a kind of “bone cement” that stabilizes the bones, allowing them to heal.

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    • Kiva. This new treatment, not yet widely available, is similar to vertebroplasty and kyphoplasty, substituting a more elastic “cement.”
    •Spinal fusion. Much less common these days, this is the treatment of last resort for people with severe VCF issues.

    It’s imperative that you pursue physical therapy for any type of VCF. The therapist will give you strengthening exercises, plus instruction in body mechanics: how to bend, lift, and perform many everyday motions the correct way, to help prevent further fractures.

    Hip fracture: This is clearly the most serious osteoporotic fracture, both in terms of treatment, and impact on life. One in 3 women (and 1 in 6 men) who reach their 90th birthday will suffer a hip fracture at some point during their lifetime.

    Statistics show that up to 20% of people who suffer a hip fracture die within a year – either due to complications from the fracture itself, or its possible side effects: blood clots, pneumonia, or infection. In addition, 75% never make a full recovery; 50% are never able to live independently again; and about 25% need to move into a nursing home.

    There are two types of hip fracture: femoral neck fracture, where the thigh bone breaks away from the “ball” of the hip’s ball and socket joint; and the less common intertrochanteric fracture, which happens slightly lower down the thigh bone.

    What’s the difference? A femoral neck fracture is usually more serious and harder to treat, as it often disrupts blood supply to the bone, which slows healing considerably. With an intertrochanteric fracture, blood supply usually isn’t affected.

    Hip fractures almost always require surgery. The most common types of surgery include the following:

    Hip pinning. This is the least serious type of surgery. The fractured bone is simply reconnected by screws.

    Partial hip replacement. In this surgery, the ball in the hip joint is replaced with a metal prosthesis, while the hip socket is left intact. A rod attached to the prosthesis is cemented into the thigh bone.

    For intertrochanteric fractures, a metal plate is attached to the side of the thigh bone, and a screw connects the plate to the ball in the hip joint. In a newer procedure, the metal plate is replaced by a rod inserted inside the thigh bone.

    Full hip replacement. This is the most serious hip surgery, and involves replacement of the entire ball and socket joint with a metal prosthesis.

  • Older patients are more likely to have hip replacement surgery than younger ones; hip replacements often aren’t effective in younger, more active patients, as they don’t last very long, and may need to be replaced.

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    Rehabilitation from hip replacement surgery is typically quite lengthy, and starts very quickly after surgery. It’s always done under the care of a physical therapist; a patient may need to spend some time in a rehabilitation facility, to get the intensive care necessary.

    After-care for hip replacement surgery includes learning how to walk, at first with a walker or cane, then on your own; learning how to use assistive devices, such as shower chairs; and instruction on preventing falls. 

    How long does all of this take? In the best-case scenario, short-term recovery takes 4 to 6 weeks. At this point, the patient should be able to walk short distances without aid, and should no longer be on major painkilling drugs. Longer term recovery, when the patient can perform everyday activities at a level prior to hip fracture, takes about 6 months.

    In the worst-case scenario, the patient is never again able to walk without considerable help.

    One final issue that arises as a result of hip fracture is difficulty taking osteoporosis medications. Bisphosphonates need to be taken sitting up; patients with a fractured hip need to stay prone, at least at first. Until the patient is able to sit up again, a bisphosphonate may need to be replaced with a drug that doesn’t require sitting up – e.g., a teriparatide, such as Forteo.

    If you have osteoporosis, chances are you’ll suffer some sort of fracture at some point. Being aware of the consequences and familiar with the treatment will help you deal with any fracture more effectively.

Published On: December 08, 2010