risk factors for falls
- age
- previous Hx
- dehydration
- vision problems
- environment
- balance/gait issues like peripheral neuropathy, parkinson’s stroke, cerebellar disease
- polypharmacy
- postural hypotension
medications that cause postural hypotension
antihypertensives
nitrates (vasodilators)
diuretics
anticholinergics
beta blockers
Ldopa
Acei
what investigations to consider for falls
lying and standing blood pressures (for postural hypotension), urine
dipstick (for UTIs, or rhabdomyolysis), ECGs (for bradycardia, or arrhythmias), blood glucose (for hypoglycaemia), FBC (for anaemia, or infections), U&Es (for dehydration, kidney problems), LFTs (for
alcohol abuse), calcium blood test (for hypo- or hypercalcaemia), CT head (for strokes, or
haemorrhage), and echocardiogram (for valvular heart disease)
what is syncope
loss of consciousness due to global cerebral hypoperfusion with a rapid onset, short durations and spontaneous complete recovery
what is osteoporosis
loss of bone mass and density
types of syncope
reflex syncope ((triggered by stress, pain, emotion etc; often referred to as
fainting), or situational (i.e. on coughing, urination, defecation)
orthostatic/postural - can be caused by disease that cause autonomic failure, drug induced or volume depletion
cardiac syncope
rfs for osteoporosis
age
female
post menopause
low Ca or Vit D
alcohol
smoking
CKD
LT steroid use
certain medications (e.g. SSRIs, PPIs, antiepileptics, anti-oestrogens, glitazones, long-term heparin, aromatase inhibitors (e.g. anastrozole))
screening tools for 10 yr risk of osteoporotic fracture
Qfracture
FRAX
whats the test for assesing bone mineral density
DEXA
T < -2.5 = osteoporosis
which conditions can cause osteoporosis
- hyperthyroid
- hyperparathyroid
- cushings syndrome
hypogonadism
coeliac disease
crohns
multiple myeloma
RA
CKD, chronic liver disease
what are the management options for osteoporosis
1) alendronic acid 70mg once weekly
2) raloxifene (SERM)
3) denosumab
other managements include: calcium and vitamin D
Main SE of bisphosphonates
- GI upset/reflex
- oesophageal erosions
- rare: osteonecrosis of jaw + external auditory canal , atypical stress fractures
presentation of vertebral fractures
Asymptomatic: an osteoporotic vertebral fracture may be diagnosed through an incidental finding on X-ray
Acute back pain
Breathing difficulties: changes in the shape and length of vertebrae lead to the compression of organs such as the lungs, heart and intestine
Gastrointestinal problems: due to compression of abdominal organs
Only a minority of patients will have a history of fall/trauma
scaphoid fractures
🦴 Scaphoid Fracture – Quick Summary
📌 Cause
FOOSH (fall onto outstretched hand)
Wrist hyperextended + radially deviated
⚠️ Why important
Risk of Avascular necrosis
👉 especially proximal fractures (retrograde blood supply)
🧍 Symptoms
Radial wrist pain (base of thumb)
↓ grip strength
🔍 Key signs (remember 3)
Snuffbox tenderness ⭐
Pain on thumb compression
Scaphoid tubercle tenderness
👉 All 3 = highly diagnostic
🩻 Investigations
X-ray first (can miss early fractures)
MRI = best test
CT for detail/healing
🚑 Management
Immobilise + refer (even if X-ray normal)
Repeat imaging in 7–10 days
Definitive:
Undisplaced → cast 6–8 weeks
Displaced / proximal → surgery
⚠️ Complications
Avascular necrosis
Non-union → osteoarthritis
what is a smiths fracture
reverse colles ( radius displaced anteriorly towards palm of hand)
garden spade deformity
what is bennett’s fracture
fratcure of first metacarpal at base of thumb in wrist
typically injured in fist fghts contact sports etc
immobilisation with a cast for 3-4 weeks if stable fracture, but if the fracture is
unstable then do surgery
galeazzi fracture
fracture of distal 1/3 of radius
+ dislocation of distal radioulnar joint
usually caused by FOOSH
surgical fixation in adults followed by immbolisation
in children closed reduction and immbolisation
what is a monteggia fracture
more common in chidlren
fracture of the proximal ulna
dislocation of the proximal radioulnar joint
cause: FOOSH
management - surgical fixation (ORIF)
management of non displaced clavicular fratcure
figure 8 bangage or sling + pain management and physio
management of displaced/complex claaviular fractures
ORIF
management of shoulder dislocations
reduction under anaestehsia or analegesia
imbolisation in arm sling for 3 weeks
what is a greenstick fracture
paediatric fracture in which there us unilateral cortical breach
Knee ligamentous injuries
🔴 ACL injury
Most common serious ligament injury
Mechanism:
Twisting + sudden stop
Change in direction (sports)
Features:
“Pop” sound
Rapid swelling (haemarthrosis)
Instability (“giving way”)
🔵 PCL injury
Mechanism:
Dashboard injury (RTA)
Fall onto bent knee
Less common than ACL
🟢 MCL injury
Mechanism:
Blow to lateral knee (valgus force)
Common in contact sports
🟡 LCL injury
Mechanism:
Blow to medial knee (varus force)
Less common
what is the unhappy triad
ACL injury
MCL injury
medial meniscus tear
caused by twisted injury or lateral blow
