Bone breaks and fractures are increasingly common injuries as we age. This is because our bones become weaker and more brittle, making breaks more likely. (See “Nursing Home Patients With Osteopenia May Suffer More Severe Injuries During Falls”).
It is also of no surprise that children are also at high risk for broken bones because of their active lifestyle, sports playing, and less developed coordination in young children.
Types of fractures:
- Stress fracture
- Spontaneous fracture
- Trauma fracture
- Growth Plate Fractures
(See “Determining The Type of Fracture A Person Has Sustained Can Reveal If Nursing Home Abuse Is Responsible” for discussion of stress, spontaneous, and trauma fractures.) It is important to keep in mind that spontaneous fractures are still rare and can be one indicator of nursing home abuse. (See “State Doesn’t Buy Claim That Patient’s Leg Spontaneously Broke”). If you suspect a family member’s bone fracture may have been the result of abuse, you should have a physician examine them for signs of trauma.
Causes of fractures
In nursing homes, many patient fractures are caused by carelessness, either in improperly evaluating a patient’s balance and mobility and adjusting the care plan or failure to execute the existing care plan. This could include failure to use belts on wheel chairs allowing the patient to slide out, failing to use bedside rails, failing to assist patients with the bathroom, and leaving patients unattended. One other significant source of fractures is trip and falls.
Elderly people are susceptible to dangerous falls because of poor balance and coordination, weakness, changes in gait, poor vision, illness, medications that cause sleepiness or dizziness. Over 11 million people over the age of 65 suffer dangerous falls every year.
Long-term care facilities need to keep walkways and areas clear of clutter because elderly patients may be unable to see these hazards or unable to step around it. (See “When Patient Safety Is An Afterthought, Employee Carelessness Frequently Results In Patient Injury”). The frustrating part of most common causes of bone fractures is that they are preventable, completely and entirely preventable. It is just another area that highlights the need for better patient care, especially for the more vulnerable members of society.
Pain related to bone fractures
Older adults are at increased risk for stress fractures, so it is important that long-term care facility staff are properly educated to recognize the signs, so the resident’s care plan can address pain management and physical therapy. Early diagnosis and treatment is important not only to reduce the pain for the resident but ensure that the fractures do not worsen. If a fracture is not promptly diagnosed and treated, any additional activity or movement can cause the patient a lot of pain and without diagnosing a cause for increased pain, staff may not properly respond to a patient’s very real pain level.
In child bone break cases, adequate pain management is also a serious concern. Rating pain in children is more difficult because of communication difficulty and conservative treatment for children. However, if a child experiences a bone break or a growth plate fracture, they will experience swelling and pain and it is important to follow up with health care professional to ensure that their pain is being properly monitored and treated. With children, it is important to first explain the pain scale then ask the child to rate their pain.
Growth plate fractures in children
Bone breaks in children are less common than with older adults because children’s bones are more pliable. Similarly, children’s bone breaks heal faster than older adults. However, children are also at risk for growth plate fractures, which can have serious long-term effects and permanent growth problems. Fractures can be caused by trauma, sports, or overuse.
Growth plates are located at the end of long bones, where the bone is actively growing and is more fragile. Any injury to a growth plate can cause bones to grow at a different rate or grow crooked. The most common locations for growth plate fractures are fingers, wrist (diagram), and lower leg.
Boys between nine and fifteen are at the highest risk of suffering a growth plate fracture. Girls over twelve are less at risk because their growth plates have usually already matured. The risk of long-term complications depends on the severity of the fracture (shifted, shattered, crushed), the age of the child (younger children have more risk) and the location of the injury (areas that grow the most, ex. knee).
Growth plate fractures are usually treated with a cast or splint, or in severe cases, surgery. Serious growth plate fractures may require follow-up visits to monitor the growth of the injured limb until the child finishes growing. If a growth plate fracture is not properly treated or if there is a delay in treatment, it can lead to a short, crooked, or disfigured limb.
Addressing bone fractures from both a causal concern and with an eye towards future needs
Bone breaks in both children and older adults are of special concern because of related complications. Delay in treatment and pain management can cause serious long-term effects such as disfigurement and growth problems.