Episodes of falling among elderly people: a systematic review and meta-analysis of social and demographic pre-disposing characteristics

CONTEXT: The multifactorial nature of falls among elderly people is well-known. Identifying the social-demographic characteristics of elderly people who fall would enable us to define the typical profile of the elderly who are at risk of falling. OBJECTIVE: We aimed to isolate studies in which the social-demographic risk factors for falls among the elderly have been evaluated and to carry out a meta-analysis by combining the results of all of these selected studies. METHOD: We did a systematic literature review using the key words "accidental fall / numerical data" and "risk factors." Inclusion criteria entailed the selection of articles with the following characteristics: population of subjects aged 60 years or over, falls that took place in everyday life, and social-demographic risk factors for falls. RESULTS: 3,747 indexed articles published between 1981 and 2007 were identified, and 177 studies with available data were included, of which 129 had data on social-demographic risk factors for falls. Difficulties in activities of daily living (ADL) or in instrumental activities of daily living (IADL) double the risk of falling: The OR and 95% Cl were 2.26 (2.09, 2.45) for disturbance ADL and 2.10 (1.68, 2.64) for IADL. The OR and 95% Cl for Caucasians were 1.68 (0.98 - 2.88) and 0.64 (0.51 - 0.80) for Hispanics. In the subgroup of patients older than eighty, being married protected people from falling with an OR and 95% Cl =0.68 (0.53 - 0.87). CONCLUSION: Defining factors that create a risk of falling and protect elderly people from falls using social-demographic characteristics lets us focus on an "at risk" population for which a specific program could be developed

Utility of cement injection to stabilize split-depression tibial plateau fracture by minimally invasive methods: A finite element analysis

International audienceTreatment for fractures of the tibial plateau is in most cases carried out by stable fixation in order to allow early mobilization. Minimally invasive technologies such as tibioplasty or stabilization by locking plate, bone augmentation and cement filling (CF) have recently been used to treat this type of fracture. The aim of this paper was to determine the mechanical behavior of the tibial plateau by numerically modeling and by quantifying the mechanical effects on the tibia mechanical properties from injury healing

Experimental analysis of mechanical response of stabilized occipitocervical junction by 3D mark tracking technique

This study is about a biomechanical comparison of some stabilization solutions for the occipitocervical junction. Four kinds of occipito-cervical fixations are analysed in this work: lateral plates fixed by two kinds of screws, lateral plates fixed by hooks and median plate. To study mechanical rigidity of each one, tests have been performed on human skulls by applying loadings and by studying mechanical response of fixations and bone. For this experimental analysis, a specific setup has been developed to impose a load corresponding to the flexion-extension physiological movements. 3D mark tracking technique is employed to measure 3D displacement fields on the bone and on the fixations. Observations of displacement evolution on the bone according to the fixation show different rigidities given by each solution

Contribution of minimally invasive bone augmentation to primary stabilization of the osteosynthesis of Schatzker type II tibial plateau fractures: Balloon vs bone tamp

International audienceBackground: Schatzker type II tibial plateau fractures necessitate the least invasive treatment possible. Arthroscopic reduction by bone tamp followed by osteosynthesis is the current gold standard for this type of tibial plateau fracture. The objective of this study was to compare this technique to anterior approach tuberoplasty with balloon reduction. The comparison criteria were residual articular step off, metaphyseal cavity volume formed during reduction, and mechanical strength to separation and to depression displacement. Methods: Fractures were created on 12 human cadaveric tibiae and reduced by a minimally invasive approach in six specimens by a balloon, and by bone tamp in the six others. Articular step off and metaphyseal-epiphyseal cavity volume were measured by TDM. Mechanical tests were performed up to assembly failure to characterize structural strength. Secondary displacements, fracture depression displacement and separation were measured by optical methods. Findings: There was no significant difference in step off measurement after balloon reduction or bone tamp (0.29 cm vs 0.37 cm; p = 0.06). The cavity volume formed by balloon reduction was significantly smaller than the volume created by bone tamp reduction (0.45 cm(3) vs 5.12 cm; p = 0.002). The compressive load required for assembly failure was significantly greater in the balloon group than in the bone tamp group (1210.17 N vs 624.50 N; p = 0.015). Interpretation: There exists a correlation between load to failure of the assembly frame and the metaphyseal volume required for bone fracture reduction. The minimally invasive balloon technique has fewer negative effects on the osseous stock, thereby enabling better primary structural strength of the fracture