Left-handedness as a risk factor for fractures

Epidemiology and Fracture Patterns of Traumatic Phalangeal Fractures

Background:

Despite the relatively high incidence of phalangeal fractures, there is an imperfect understanding of the epidemiology and anatomical distribution of these fractures. This study describes the patient characteristics, anatomic distribution, and detailed fracture patterns of phalangeal fractures among a large adult cohort in the United States.

Methods:

A retrospective study was performed among patients with phalangeal fractures in the United States between January 2010 and January 2015. Included patients were 18 years old or older and had a diagnosis of a phalangeal fracture. A total of 2140 phalangeal fractures in 1747 patients were included, and a manual chart review was performed to collect epidemiological and radiographic information. Fractures were classified based on location and fracture pattern.

Results:

The median age at the time of injury was 45 years (interquartile range, 30–57), and 65% of patients were men. The small finger had the highest incidence of fractures (26%) followed by the ring finger (24%). Distal and proximal phalanges demonstrated the highest incidence of fractures at 39% each. The dominant hand was affected in 44% of cases. Eighteen percent of fractures were due to a work-related trauma mechanism, and the most common mechanism of injury was blunt trauma (46%).

Conclusion:

This study provides a detailed overview of the anatomic distribution and fracture patterns of phalangeal fractures in an adult US population and, thus, may aid hand surgeons treating these injuries.

Assessment of some demographic risk factors associated with diaphyseal humeral fractures among Nigerians

Background

The epidemiology of fractures of the humeral shaft has received little attention in Nigeria. This study was aimed at investigating the possible risk factors associated with diaphyseal humeral fractures among Nigerians.

Methods

The study was carried out retrospectively at the Department of Medical Records, National Orthopaedic Hospital, Igbobi, Lagos State, Nigeria, between 2007 and 2012. Case notes and plain films of X-ray from a total number of 206 patients of ages from birth to one hundred years (0–100 years), comprising of 140 males and 66 females, were used for the study. The analyses were done using Statistical Package for Social Sciences (SPSS) version 16.0 and presented in bar charts. The frequencies were reported as percentages. The differences in frequencies were compared using chi-square test.

Results

The results showed that the percentage frequency of diaphyseal humeral fractures was significantly higher (P < 0.05) in males than in females. The main cause (P < 0.05) of diaphyseal humeral fractures was road traffic accident followed by fall.

Conclusions

The major causes of diaphyseal humeral fractures are road traffic accidents and falls. Since diaphyseal humeral fracture is an issue of harsh economic consequences, adequate measures should be taken by all the parties involved, especially government agencies, to address this menace in term of road maintenance and general well-being of the citizens. Furthermore, since it was observed that different regions of the bones of interest present diverse characteristics with respect to associated risk factors, it is recommended that such studies as this should be region-based rather than whole-bone based.

Electronic supplementary material

The online version of this article (doi:10.1186/s41038-015-0007-7) contains supplementary material, which is available to authorized users.

The occurrence of ipsilateral or contralateral foot disorders and hand dominance: the Framingham foot study

BACKGROUND

To our knowledge, hand dominance and side of foot disorders has not been described in the literature. We sought to evaluate whether hand dominance was associated with ipsilateral foot disorders in community-dwelling older men and women.

METHODS

Data were from the Framingham Foot Study (N = 2,089, examined 2002-2008). Hand preference for writing was used to classify hand dominance. Foot disorders and side of disorders were based on validated foot examination findings. Generalized linear models with generalized estimating equations were used to estimate odds ratios and 95% confidence intervals, accounting for intraperson variability.

RESULTS

Left-handed people were less likely to have foot pain or any foot disorders ipsilateral but were more likely to have hallux valgus ipsilateral to the left hand. Among right-handed people, the following statistically significant increased odds of having an ipsilateral versus contralateral foot disorder were seen: 30% for Morton's neuroma, 18% for hammer toes, 21% for lesser toe deformity, and a twofold increased odds of any foot disorder; there was a 17% decreased odds for Tailor's bunion and an 11% decreased odds for pes cavus.

CONCLUSIONS

For the 2,089 study participants, certain forefoot disorders were shown to be ipsilateral and others were contralateral to the dominant hand. Future studies should examine whether the same biological mechanism that explains ipsilateral hand and foot preference may explain ipsilateral hand dominance and forefoot disorders.

Mixed handedness is associated with greater age-related decline in volumes of the hippocampus and amygdala: the PATH through life study

Handedness has been found to be associated with structural and functional cerebral differences. Left handedness and mixed handedness also appear to be associated with an elevated risk of some developmental and immunological disorders that may contribute to pathological processes developing in ageing. Inconsistent reports show that left handedness may be more prevalent in early-onset as well as late-onset Alzheimer's disease, but might also be associated with slower decline. Such inconsistencies may be due to handedness being usually modeled as a binary construct while substantial evidence suggests it to be a continuous trait. The aim of this study was to investigate the relationship between brain structures known to be implicated in pathological ageing and strength and direction of handedness. The association between handedness and hippocampal and amygdalar atrophy was investigated in 327 cognitively healthy older individuals. Handedness was measured with the Edinburgh Inventory. Two measures were computed from this index, one reflecting the direction (left = 0/right = 1) and the other the degree of handedness (ranging from 0 to 1). Hippocampal and amygdalar volumes were manually traced on scans acquired 4 years apart. Regression analyses were used to assess the relationship between strength and direction of handedness and incident hippocampal and amygdalar atrophy. Analyses showed that strength but not direction of handedness was a significant predictor of hippocampal (Left: beta = 0.118, P = 0.013; Right: beta = 0.116, P = 0.010) and amygdalar (Right: beta = 0.105, P = 0.040) atrophy. The present findings suggest that mixed but not left handedness is associated with greater hippocampal and amygdalar atrophy. This effect may be due to genetic, environmental, or behavioural differences that will need further investigation in future studies.

[Left-handedness and health]

Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome), developmental disorders (autism, dislexia and sttutering) and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about "anomalous" cerebral domination, as a consequence of hormonal disbalance.

Complex and unstable simple elbow dislocations: a review and quantitative analysis of individual patient data

Objective:

The primary objective of this review of the literature with quantitative analysis of individual patient data was to identify the results of available treatments for complex elbow dislocations and unstable simple elbow dislocations. The secondary objective was to compare the results of patients with complex elbow dislocations and unstable elbow joints after repositioning of simple elbow dislocations, which were treated with an external fixator versus without an external fixator.

Search Strategy:

Electronic databases MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials.

Selection Criteria:

Studies were eligible for inclusion if they included individual patient data of patients with complex elbow dislocations and unstable simple elbow dislocations.

Data Analysis:

The different outcome measures (MEPI, Broberg and Morrey, ASES, DASH, ROM, arthritis grading) are presented with mean and confidence intervals.

Main Results:

The outcome measures show an acceptable range of motion with good functional scores of the different questionnaires and a low mean arthritis score. Thus, treatment of complex elbow dislocations with ORIF led to a moderate to good result. Treatment of unstable simple elbow dislocations with repair of the collateral ligaments with or without the combination of an external fixator is also a good option.

The physician-rated (MEPI, Broberg and Morrey), patient-rated (DASH) and physician- and patient-rated (ASES) questionnaires showed good intercorrelations.

Arthritis classification by x-ray is only fairly correlated with range of motion.

Elbow dislocations are mainly on the non-dominant side.

Dislocation of the Elbow: A Retrospective Multicentre Study of 86 Patients

The objective of this retrospective multicentre cohort study was to prospectively assess the long-term functional outcomes of simple and complex elbow dislocations.

We analysed the hospital and outpatient records of 86 patients between 01.03.1999 and 25.02.2009 with an elbow dislocation. After a mean follow-up of 3.3 years, all patients were re-examined at the outpatient clinic for measurement of different outcomes.

The mean range of motion was ROM 135.5°. The Mayo elbow performance index (MEPI) scored an average of 91.9 (87.5% of the patients were rated excellent or good). The average Quick disabilities of the arm, shoulder and hand (Quick- DASH) score was 9.7, the sports/music score 11.5 and work score 6.1. The Oxford function score was 75.7, Oxford pain score 75.2 and Oxford social-psychological score 73.9.

Elbow dislocation is a mild disease and generally, the outcome is excellent. Functional results might improve with early active movements.

Dislocation of the elbow: a retrospective multicentre study of 86 patients

The objective of this retrospective multicentre cohort study was to prospectively assess the long-term functional outcomes of simple and complex elbow dislocations.

We analysed the hospital and outpatient records of 86 patients between 01.03.1999 and 25.02.2009 with an elbow dislocation. After a mean follow-up of 3.3 years, all patients were re-examined at the outpatient clinic for measurement of different outcomes.

The mean range of motion was ROM 135.5°. The Mayo elbow performance index (MEPI) scored an average of 91.9 (87.5% of the patients were rated excellent or good). The average Quick disabilities of the arm, shoulder and hand (Quick- DASH) score was 9.7, the sports/music score 11.5 and work score 6.1. The Oxford function score was 75.7, Oxford pain score 75.2 and Oxford social-psychological score 73.9.

Elbow dislocation is a mild disease and generally, the outcome is excellent. Functional results might improve with early active movements.

Four score years and ten: an analysis of the epidemiology of fractures in the very elderly

Fragility fractures are becoming more common and with increasing longevity it seems likely that orthopaedic surgeons will see more such fractures in progressively older patients. We have examined the epidemiology of fractures in patients aged 90 years or more.

INTRODUCTION

The purpose of this study was to examine the epidemiology of fractures in the very elderly to see if it differed from the overall fracture epidemiology. The requirement for hospital admission and surgical treatment was assessed as was the patients' domicile, length of hospital stay and discharge location.

MATERIALS AND METHODS

All fractures presenting to the Royal Infirmary of Edinburgh and the Royal Hospital for Sick Children in 2000 were examined prospectively and recorded on databases. A retrospective examination of the clinical and social details of the 90+ age group was undertaken.

RESULTS

The 90+ age group comprises 0.58% of the population but accounts for 3.02% of the fractures in the community, 8.7% of the in-patient admissions and 7.6% of the acute orthopaedic trauma surgery. About 56% of fractures in this age group are proximal femoral fractures but high prevalences were noted for all femoral fractures. About 65% of the fractures were in the lower limb. Over 86% of fractures occurred in falls and over 81% of patients were treated as in-patients. The average hospital stay was 9 days but only 23.9% were discharged to their domicile.

DISCUSSION

It is forecast that this age group will increase and become less fit. This has significant implications for hospital treatment and costs.

The laterality of the surgical correction of forefoot pathology

Lateral prevalence has not been traditionally attributed to the development and presentation of pathologic forefoot complaints. The objective of this study was to determine if a laterality prevalence exists for surgically corrected forefoot deformities. All cases performed at the Inova Fairfax Hospital Ambulatory Surgery Center over a 76-month period were reviewed and classified into the following categories: hallux abductovalgus deformity correction, hallux limitus deformity correction, specific digital deformity correction, neuroma surgery, and combinations of these categories (n = 1821). Our analyses indicated no laterality difference in the surgical correction of most common forefoot pathologies. A measure of all examined surgical corrections (hallux abductovalgus, hallux limitus, digital deformity, and/or neuroma) did not demonstrate a difference between the surgical correction of the right and left extremities (chi(2) = 0.003; P = .94). There was also no significant difference in the surgical correction of the right and left extremities when studying the individual categories of any hallux abductovalgus correction (chi(2) = 0.416; P = .52), any hallux limitus correction (chi(2) = 2.050; P = .15), any digital deformity correction (chi(2) = 1.251; P = .26), or any neuroma surgery (chi(2) = 0.784; P = .38). Only the surgical correction of hallux limitus deformity without surgical correction of digital deformity or neuroma demonstrated a significant laterality with surgical correction of the right lower extremity being more common (chi(2) = 4.600; P = .03).

LEVEL OF EVIDENCE

2.

Risk factors for fracture of the shafts of the tibia and fibula in older individuals

A case-control study to identify risk factors for fracture of the shafts of the tibia and fibula among persons 45 years of age and older was undertaken in five Northern California Kaiser Permanente Medical Centers during 1996-2001. One hundred seventy-nine cases of newly diagnosed fracture of the tibia/fibula shaft and 2,399 controls sampled from the membership lists of the same five medical centers were included. Information on potential risk factors was obtained by a standardized questionnaire administered by trained interviewers. The number of previous fractures was associated with an increased risk [adjusted odds ratio (OR) (95% confidence interval)=1.49 (1.09-2.03) per previous fracture]. Attributes known or thought to be associated with protection against loss of bone mass, including high body mass index [adjusted OR=0.82 (0.69-0.97) per 5 kg/m2 increase], having ever used thiazide diuretics or water pills for at least 1 year [adjusted OR=0.62 (0.38-1.02)], and current use of menopausal hormone therapy among females [adjusted OR=0.84 (0.53-1.32)] tended to show decreased risks. Factors generally associated with lower bone mass, such as current cigarette smoking [OR=1.55 (1.01-2.39)] and, to some extent, lack of physical activity [OR=1.31 (0.87-1.96) for the lowest quartile compared to the upper three quartiles], tended to demonstrate increased risks. The number of falls in the past year and risk factors for falls were not associated with tibia/fibula shaft fractures, and indicators of health status were weakly and inconsistently associated with risk. Thus, this study suggests that risk factors for low bone mass, but not health status or risk factors for falls, may be important in the etiology of fracture of the shaft of the tibia/fibula in older individuals.

Risk factors for pelvis fracture in older persons

From 1996 to 2001, the authors undertook a case-control study of 192 pelvis fracture cases (men and women) and 2,402 controls aged > or = 45 years at five Kaiser Permanente medical centers in Northern California. Most information on potential risk factors was obtained by means of an interviewer-administered questionnaire. Number of fractures since age 45 years and a maternal history of hip fracture were associated with increased risks. Several factors thought to protect against loss of bone mass, including recent use of menopausal hormone therapy (adjusted odds ratio (OR) = 0.55, 95% confidence interval (CI): 0.33, 0.91) and high body mass index (weight (kg)/height (m)2; per 5-unit increase, adjusted OR = 0.65, 95% CI: 0.52, 0.81), were associated with decreased risks, while cigarette smoking (adjusted OR = 2.17, 95% CI: 1.34, 3.52) and hysterectomy (adjusted OR = 1.75, 95% CI: 1.15, 2.66) were associated with increased risks. Various conditions related to propensity to fall were associated with increased risks. Most indicators of frailty, including use of walking aids and needing help with or being unable to perform various activities of daily living, conferred increased risks. Thus, low bone mass, frailty, and probably a propensity to fall appear to be associated with increased risk of pelvis fracture.

Reducing the risk for distal forearm fracture: preserve bone mass, slow down, and don't fall!

A case-control study of 1,150 female and male distal forearm cases and 2,331 controls of age 45 years and older was undertaken from 1996-2001 in five Northern California Kaiser Permanente Medical Centers. Most information on possible risk factors was obtained by an interviewer-administered questionnaire, supplemented by a few tests of lower extremity neurological function. Previous fractures since 45 years of age, a rough marker of osteoporosis, were associated with an increased risk (adjusted odds ratio [OR] [95% confidence interval] = 1.48 [1.20-1.84 ] per previous fracture). Several factors thought to protect against low bone mass were associated with a reduced risk, including current use of menopausal hormone therapy (adjusted OR = 0.60 [0.49-0.74]), ever used thiazide diuretics or water pills for at least 1 year (adjusted OR = 0.79 [0.64-0.97]), high body mass index (weight in kg/height in m2) (adjusted OR = 0.96 [0.89-1.04] per 5 unit increase), and high dietary calcium intake (adjusted OR = 0.88 [0.75-1.03] per 500 mg/day). Falls in the past year and conditions associated with falling, such as epilepsy and/or use of seizure medication (adjusted OR = 2.07 [1.35-3.17]) and a history of practitioner-diagnosed depression (adjusted OR = 1.40 [1.13-1.73]), were associated with increased risks. Having difficulty performing physical functions and all lower-extremity problems measured in this study were associated with reduced risks. The results from this and other studies indicate that distal forearm fractures tend to occur in people with low bone mass who are otherwise in relatively good health and are physically active, but who are somewhat prone to falling (particularly on an outstretched hand), and whose movements are not slowed by lower extremity problems and other debilities. Thus, measures to decrease fall frequency and to slow down the pace of relatively healthy people with low bone mass should lead to a lower frequency of distal forearm fracture.