Fractures
What are fractures?
Fractures are broken bones.
What are the complaints associated with fractures?
Fractures present as follows: pain, restricted movement and malposition, and even delirium. It often happens that broken bones in people with intellectual disabilities are not noticed or only seen after a considerable length of time.
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People with intellectual disabilities sometimes find it impossible to communicate pain. The people around them may then notice only a change in behaviour and restricted movement.
How common are fractures in the general population?
Annually, 0.91% of people see a GP with a fracture.
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This is less than the actual rate of fractures because it does not include people who go straight to the hospital.
How common are fractures in people with intellectual disabilities?
Fractures are seen 1.8 to 3.4 times more often in people with intellectual disabilities than in the general population.
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In a follow-up study, fractures were seen more frequently in men than in women, and most were peripheral fractures (in other words, fractures of the hand, foot, wrist or ankle).
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A large Irish study conducted recently of older people with intellectual disabilities found a lifetime prevalence of 20%. The rate was the same in men and women. People with epilepsy and people who used anti-epileptics had a higher risk of fractures.
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The Dutch GOUD study found that 25% of older people with intellectual disabilities suffered a fracture during the 3-year follow-up.
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A file study of women with intellectual disabilities who did not live in an institution found that 32% suffered fractures in adulthood. Of these fractures, 3.51% were hip fractures and 84.2% were in the extremities. Risk factors for fractures were the use of anti-epileptics, older age and being post-menopausal. But it is also important to watch out for fractures in younger people in this population.
People do not always communicate pain well or they continue to walk around with fractures, which makes diagnosis and treatment more difficult.
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Another study of people with intellectual disabilities in an institution found that there was a major problem – an incidence of 7.3% – with fractures in the extremities.
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A Dutch study of health problems in people with intellectual disabilities found that 5.0% had suffered a lower leg fracture, 2.8 times as many as the 1.9% in the general population.
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Dutch researchers also looked at the interval between an injury and the identification of the fracture. The average interval was 59.2 hours. When the group was broken down into a group in which fractures were identified quickly and a group in which fractures were identified after a delay, the median interval was 13 hours in the quicker group and 28 hours in the delayed group. Factors associated with a long interval were: a fracture in the cervical vertebrae, a severe or very severe intellectual disability, non-verbal communications between the client and the staff, and autism. Factors associated with a shorter interval were a combination of pain, functional impairment and the external signs of a fracture, the location of the fracture in the upper arm and lower leg, and a mild intellectual disability.
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There is no information about this area for the general population. 26% People with intellectual disabilities
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561Coenen M, van Hedel Y, Huls R, Traas D. Onderzoek Fract-uur: uren tussen het trauma en het vaststellen van de fractuur. Leeronderzoek ihkv de AVG-opleiding. www.erasmusmc.nl/avgopleiding > leeronderzoeken. December 2011.
Coenen M, van Hedel Y, Huls R, Traas D. Onderzoek Fract-uur: uren tussen het trauma en het vaststellen van de fractuur. Leeronderzoek ihkv de AVG-opleiding. www.erasmusmc.nl/avgopleiding > leeronderzoeken. December 2011.
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295Linden van der MW, Wester GP, de Bakker DH, Schellevis FG. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk: klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrecht/Bilthoven: NIVEL/RIVM 2004.
Linden van der MW, Wester GP, de Bakker DH, Schellevis FG. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk: klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrecht/Bilthoven: NIVEL/RIVM 2004.
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296Tannenbaum TN, Lipworth L, Baker S. Risk of fractures in an intermediate care facility for persons with mental retardation. Am J Ment Retard. 1989 Jan;93(4):444-51.
Tannenbaum TN, Lipworth L, Baker S. Risk of fractures in an intermediate care facility for persons with mental retardation. Am J Ment Retard. 1989 Jan;93(4):444-51.
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297Schrojenstein Lantman-de Valk van HMJ, Metsemakers JFM, Haveman MJ, Crebolder HFJM. Health problems in peolple with intellectuel disability in general practice: a comperative study. Familiy Practice 2000. Vol17.No5 405-7
Schrojenstein Lantman-de Valk van HMJ, Metsemakers JFM, Haveman MJ, Crebolder HFJM. Health problems in peolple with intellectuel disability in general practice: a comperative study. Familiy Practice 2000. Vol17.No5 405-7
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298Vanlint S, Nugent M. Vitamin D and fractures in people with intellectual disability. J Intellect Disabil Res. 2006 Oct;50(Pt 10):761-7.
Vanlint S, Nugent M. Vitamin D and fractures in people with intellectual disability. J Intellect Disabil Res. 2006 Oct;50(Pt 10):761-7.
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298Vanlint S, Nugent M. Vitamin D and fractures in people with intellectual disability. J Intellect Disabil Res. 2006 Oct;50(Pt 10):761-7.
Vanlint S, Nugent M. Vitamin D and fractures in people with intellectual disability. J Intellect Disabil Res. 2006 Oct;50(Pt 10):761-7.
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563Burke EA, McCallion P, Carroll R, Walsh JB, McCarron M. An exploration of the bone health of older adults with an intellectual disability in Ireland. J Intellect Disabil Res. 2016 Apr 21. doi: 10.1111/jir.12273.
Burke EA, McCallion P, Carroll R, Walsh JB, McCarron M. An exploration of the bone health of older adults with an intellectual disability in Ireland. J Intellect Disabil Res. 2016 Apr 21. doi: 10.1111/jir.12273.
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562Schoufour JD, Echteld MA, Bastiaanse LP, Evenhuis HM. The use of a frailty index to predict adverse health outcomes (falls, fractures, hospitalization, medication use, comorbid conditions) in people with intellectual disabilities. Res Dev Disabil. 2015 Mar;38:39-47.
Schoufour JD, Echteld MA, Bastiaanse LP, Evenhuis HM. The use of a frailty index to predict adverse health outcomes (falls, fractures, hospitalization, medication use, comorbid conditions) in people with intellectual disabilities. Res Dev Disabil. 2015 Mar;38:39-47.
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299Schrager S, Kloss C, Ju AW. Prevalence of fractures in women with intellectual disabilities: a chart review. J Intellect Disabil Res. 2007 Apr;51(Pt 4):253-9.
Schrager S, Kloss C, Ju AW. Prevalence of fractures in women with intellectual disabilities: a chart review. J Intellect Disabil Res. 2007 Apr;51(Pt 4):253-9.
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300Ryder KM, Williams J, Womack C, Nayak NG, Nasef S, Bush A, Tylavsky FA, Carbone L. Appendicular fractures: a significant problem among institutionalized adults with developmental disabilities. Am J Ment Retard. 2003 Sep;108(5):340-6.
Ryder KM, Williams J, Womack C, Nayak NG, Nasef S, Bush A, Tylavsky FA, Carbone L. Appendicular fractures: a significant problem among institutionalized adults with developmental disabilities. Am J Ment Retard. 2003 Sep;108(5):340-6.
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297Schrojenstein Lantman-de Valk van HMJ, Metsemakers JFM, Haveman MJ, Crebolder HFJM. Health problems in peolple with intellectuel disability in general practice: a comperative study. Familiy Practice 2000. Vol17.No5 405-7
Schrojenstein Lantman-de Valk van HMJ, Metsemakers JFM, Haveman MJ, Crebolder HFJM. Health problems in peolple with intellectuel disability in general practice: a comperative study. Familiy Practice 2000. Vol17.No5 405-7
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561Coenen M, van Hedel Y, Huls R, Traas D. Onderzoek Fract-uur: uren tussen het trauma en het vaststellen van de fractuur. Leeronderzoek ihkv de AVG-opleiding. www.erasmusmc.nl/avgopleiding > leeronderzoeken. December 2011.
Coenen M, van Hedel Y, Huls R, Traas D. Onderzoek Fract-uur: uren tussen het trauma en het vaststellen van de fractuur. Leeronderzoek ihkv de AVG-opleiding. www.erasmusmc.nl/avgopleiding > leeronderzoeken. December 2011.