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. ⁵⁹¹

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. ³⁶⁷
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. ³⁶⁸ , ³⁶⁹ , ³⁷⁰

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). ³⁷⁰

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. ⁵⁹³

The Dutch GOUD study found that 25% of older people with intellectual disabilities suffered a fracture during the 3-year follow-up. ⁵⁹²

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. ³⁷¹

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. ³⁷²

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. ³⁶⁹

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. ⁵⁹¹

There is no information about this area for the general population. 26% People with intellectual disabilities