POSTURAL CONTROL, VESTIBULAR FUNCTION AND PLANTAR PRESSURE SENSATION AMONG PEOPLE WITH FALL-RELATED WRIST FRACTURES: A CASE CONTROL STUDY

Baldursdottir B.^1,2, Jonsson P.V.^1,2, Petersen H.^1,2, Mogensen B.^1,2, Whitney S.L.³, Kristinsdottir E.K.¹

¹University of Iceland, Faculty of Medicine, Reykjavik, Iceland, ²Landspitali, University Hospital, Reykjavik, Iceland, ³University of Pittsburgh, Pittsburg, United States

Background: Fall-related fractures rise significantly with increasing age. Wrist fractures may be a precursor to the more serious hip fractures, which can result in decreased quality of life, increased health care costs, and death in the elderly. The associations of postural control, vestibular function and plantar pressure sensation with wrist fractures are not clear.

Purpose: To investigate whether individuals with fall-related wrist fractures have poorer postural control, vestibular function and plantar pressure sensation compared to matched controls.

Methods: A case controlled study consisting of 98 individuals aged 50-75 years having sustained a fall-related wrist fracture, identified from medical records at the emergency department at Landspitali University Hospital in Iceland, were included. Fifty healthy individuals without previous history of fall-related wrist fractures, matched according to age, gender and weekly physical activity level during the previous 12 months served as controls. Measurements included the Head-Shake test (HST) to screen for vestibular dysfunction, Semmes-Weinstein monofilaments to record plantar pressure sensation (MF) and the Sensory Organization Test (SOT) for assessment of postural control.

Results: A positive HST (> 3 fast eye beats) was noted among 39% of the subjects and in 24% of the controls (p = 0.73). The intensity of nystagmus was stronger amongst the subjects than the controls (> 6 fast eye beats 14.3% versus 4.0% and down beating torsional nystagmus 11.2% versus 0%, P = 0.012). Plantar pressure sensation was significantly poorer (p = 0.00) among the subjects compared to controls. The SOT composite scores were lower among subjects indicating worse balance (p = 0.000) and their median scores were as well lower in Condition 2 (p=0.01), Condition 5 (p=0.001) and in Condition 6 (p=0.01).

Conclusion(s): Wrist fracture subjects have poorer standing and dynamic postural control, greater evidence of vestibular dysfunction and reduced pressure sensation on the soles of their feet compared to individuals with-out fall-related wrist fractures. Balance and vestibular dysfunction as well as reduced pressure sensation on the soles of the feet could be an underlying cause of fall-related wrist fractures.

Implications: Currently people aged 50-75 years who sustain a fall-related wrist fracture only receive treatment of the fracture. Postural control is usually not evaluated as limited knowledge exists about whether age-related degenerative chances in the sensory systems are affecting the control of posture in this age group who fracture their wrist. The results of the study suggest that reduced plantar sensation could be an important contributing factor to falls and subsequent wrist fractures among the ageing population. Interest should be directed to balance dysfunction together with the status of sensation in the lower extremities among people with fall-related wrist fractures. Exercises that facilitate the function of the somatosensory system and the improvement of postural control might decrease the incidence of recurrent falls and fractures.

Funding acknowledgements: St. Josef´s Hospital Fund, Iceland
Landspitali University Hospital Research Fund
Icelandic Physiotherapy Association Research Fund
Icelandic Gerontological Society Research Fund

Topic: Professional practice: other

Ethics approval: Approved by the National Bioethics Committee (VSNb2013110036/03.11), IS

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