From the Research
The prevalence of pubic ramus fractures in long-term care settings with residents who have recurrent falls is a significant concern, with these fractures often resulting from low-energy lateral falls directly onto the hip, and prevention strategies should include comprehensive fall risk assessments, medication reviews, and vitamin D supplementation, as suggested by recent studies 1.
Key Points
- Pubic ramus fractures occur more commonly in elderly residents with osteoporosis, particularly women over 75 years of age.
- Risk factors include female gender, advanced age, osteoporosis, polypharmacy, cognitive impairment, and gait instability.
- Prevention strategies should include:
- Comprehensive fall risk assessments
- Medication reviews to minimize fall-risk medications
- Vitamin D supplementation (800-1000 IU daily with calcium 1200mg daily)
- Appropriate mobility aids
- Hip protectors
- Environmental modifications
- Early identification is crucial as these fractures may present subtly with groin pain, difficulty weight-bearing, or pain with hip rotation, and can be missed on initial assessment, leading to delayed diagnosis in approximately 30% of cases in LTC settings.
Relevant Evidence
- A recent study published in 2022 in the journal Osteoporosis International 1 provides guidance on the prevention and treatment of osteoporosis, highlighting the importance of comprehensive fall risk assessments and vitamin D supplementation in preventing fractures.
- Another study published in 2018 in the journal The Journals of Gerontology 2 found that residents with the highest fall frequency were less likely to sustain an injury per fall, suggesting that prevention strategies should target both frequent and infrequent fallers.
Clinical Implications
- Clinicians should prioritize the prevention of pubic ramus fractures in long-term care settings by implementing comprehensive fall risk assessments and prevention strategies.
- Vitamin D supplementation and medication reviews should be considered as part of a multifaceted approach to preventing fractures in this population.
- Early identification and treatment of pubic ramus fractures are crucial to preventing delayed diagnosis and improving outcomes in long-term care settings.