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      Characteristics of sagittal spine alignment in female patients with distal radius fractures due to fall

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          Abstract

          Objectives

          Distal radius fractures occur due to reflex clasp when falling. Recently, attention has been focused on the strong relationship between sagittal spine alignment and falls. Therefore, we investigated the parameters of sagittal spinal alignment in distal radius fractures in female patients.

          Patients and methods

          The subjects were group D: 28 female patients with distal radius fractures aged 50 years or older (mean age: 69.3 years), and group C: 26 healthy female patients without a history of fragility fractures (mean age: 70.5 years). Height, body weight, and body mass index (BMI) were measured as physical indices. As parameters of sagittal spinal alignment, the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumber lordosis (LL), and thoracic kyphosis (TK) were measured on lateral whole-spine plain radiographs in a standing position. The measured physical indices and sagittal spinal alignment parameters were compared between groups.

          Results

          Height, weight, and BMI did not differ significantly between the two groups. Among the sagittal spinal alignment parameters, PT, PI, SS, LL, and TK did not differ significantly between groups, whereas SVA was significantly higher in group D than in group C (P < 0.05).

          Conclusion

          In this study, SVA was significantly higher in group D than in group C. As SVA increased, the center of gravity of the body shifts forward, which can cause the body to lose balance and fall. This study suggested that an increase in SVA is associated with distal radius fractures.

          Abstract

          Emergency medicine, Medical imaging, Metabolism, Public health, Rehabilitation; Surgery; Biomechanics; Aging; Orthopedics; Trauma; Aging and life course; Distal radius fractures; Spinal sagittal balance; Sagittal vertical axis; Fall.

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          Most cited references21

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          A physiological profile approach to falls risk assessment and prevention.

          The purpose of this perspective article is to describe the use of a physiological profile approach to falls risk assessment and prevention that has been developed by the Falls and Balance Research Group of the Prince of Wales Medical Research Institute, Sydney, Australia. The profile's use for people with a variety of factors that put them at risk for falls is discussed. The Physiological Profile Assessment (PPA) involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The tests can be administered quickly, and all equipment needed is portable. The results can be used to differentiate people who are at risk for falls ("fallers") from people who are not at risk for falls ("nonfallers"). A computer program using data from the PPA can be used to assess an individual's performance in relation to a normative database so that deficits can be targeted for intervention. The PPA provides valid and reliable measurements that can be used for assessing falls risk and evaluating the effectiveness of interventions and is suitable for use in a range of physical therapy and health care settings.
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            Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength.

            This controlled trial was designed to investigate the influence of osteoporosis-related kyphosis (O-K) on falls. Twelve community-dwelling women with O-K (Cobb angle, 50-65 degrees measured from spine radiographs) and 13 healthy women serving as controls were enrolled. Mean age of the O-K group was 76 years (+/-5.1), height 158 cm (+/-5), and weight 61 kg (+/-7.9), and mean age of the control group was 71 years (+/-4.6), height 161 cm (+/-3.8), and weight 66 kg (+/-11.7). Quantitative isometric strength data were collected. Gait was monitored during unobstructed level walking and during stepping over an obstacle of four different heights randomly assigned (2.5%, 5%, 10%, and 15% of the subject's height). Balance was objectively assessed with computerized dynamic posturography consisting of the sensory organization test. Back extensor strength, grip strength, and all lower extremity muscle groups were significantly weaker in the O-K group than the control group (P <0.05), except right ankle plantar flexors (P =0.09). There was a significant difference in the anteroposterior and mediolateral displacements and velocities. The O-K subjects had less anteroposterior displacement, greater mediolateral displacement, reduced anteroposterior velocity, and increased mediolateral velocity compared with controls for all conditions of unobstructed and obstructed level walking. Obstacle height had a significant effect on all center-of-mass variables. The O-K subjects had significantly greater balance abnormalities on computerized dynamic posturography than the control group (P =0.002). Data show that thoracic hyperkyphosis on a background of reduced muscle strength plays an important role in increasing body sway, gait unsteadiness, and risk of falls in osteoporosis.
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              Thoracic kyphosis: range in normal subjects.

              Thoracic kyphosis was measured on chest radiographs of 316 "normal" subjects by means of a modification of the Cobb technique for measuring scoliosis. Patients were accepted as "normal" if they had no thoracic or spinal complaints or radiographic abnormalities in the chest including the thoracic spine. A total of 159 males and 157 female subjects 2-77 years old was studied. The relation among age, gender, and kyphosis were determined using least squares fits of first-order linear mathematical models. These results were also used to determine the expected ranges of kyphosis for a "normal" patient of a given age and gender. The degree of kyphosis increased with age and the rate of increase was higher in females than in males. Clinical explanations for this differential increase are discussed.
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                Author and article information

                Contributors
                Journal
                Heliyon
                Heliyon
                Heliyon
                Elsevier
                2405-8440
                20 August 2020
                August 2020
                20 August 2020
                : 6
                : 8
                : e04756
                Affiliations
                [a ]Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
                [b ]Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
                Author notes
                []Corresponding author. knaito@ 123456juntendo.ac.jp
                Article
                S2405-8440(20)31599-1 e04756
                10.1016/j.heliyon.2020.e04756
                7452564
                32904191
                9d5720ec-b436-454e-ad41-06d950cdba86
                © 2020 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 28 May 2020
                : 17 July 2020
                : 17 August 2020
                Categories
                Article

                emergency medicine,medical imaging,metabolism,public health,rehabilitation,surgery,biomechanics,aging,orthopedics,trauma,aging and life course,distal radius fractures,spinal sagittal balance,sagittal vertical axis,fall

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