To better understand the connection between bone fracture risk and obesity, researchers tracked 20,000 Canadian men and women between the ages of 40 and 70. During a mean follow-up of 5.8 years, 497 women and 323 men suffered a fracture. There were 416 major osteoporotic fractures, with 260 in women and 155 in men, 353 leg fractures, with 219 in women and 134 in men, and 203 arm fractures, with 141 in women and 62 in men (some fractures were double classified).

Next, researchers looked at waist circumference and cross-referenced it with fracture data. What they found was that for every two-inch increase in waist circumference in women, the risk fracture at any site was 3 percent higher and the risk of a leg fracture was 7 percent higher. The strongest link between waist circumference and ankle fractures was when examining ankle fractures. Here’s a look at some more statistics from the survey:

• In women, greater body mass index was associated with a greater risk of leg fractures.
• Compared with women with a BMI of 25, those with a BMI of 27.5 had a five percent greater risk of leg fractures, while those with a BMI over 40 had a 40 percent higher risk.
• Conversely, those with a BMI of 22.5 had a five percent lower risk.

Researchers stopped short of saying exactly why obesity is associated with a higher risk of fracture in women, but they believe it’s likely due in part to the fact that many fractures are caused by falls, and falls are more common among overweight and obese individuals.

“Waist circumference was more strongly associated with fractures in women than BMI. This may be due to visceral fat — fat that is very metabolically active and stored deep within the abdomen, wrapped around the organs — secreting compounds that adversely affect bone strength,” said study author Dr. Anne-Frederique Turcotte, from the endocrinology and nephrology unit at CHU de Quebec Research Centre, in Quebec City. “We also know that people with obesity take longer to stabilize their body, when they trip, for example. This is particularly pronounced when weight is concentrated at the front of the body, suggesting that individuals with distribution of body fat in the abdominal area may be at higher risk of falling.”

Interestingly, among men, a higher BMI and greater waist circumference were not significantly associated with fractures.

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According to a joint study out of the University of Oxford and University of Bristol, nutrients found in meat may help to decrease bone fracture risk. For the study, researchers examined the medical data and dietary habits of more than 50,000 people in the United Kingdom. After examining the data, they found that  vegans with lower calcium and protein levels than meat eaters had a 43 percent higher chance of fracturing a bone, specifically in their leg, hip or spine. Vegetarians and pescatarians had an increased risk of hip fractures compared to meat eaters.

“This is the first comprehensive study on the risks of both total and site-specific fractures in people of different diet groups,” said Dr. Tammy Tong, a nutritional epidemiologist from Oxford in a news release. “We found that vegans had a higher risk of total fractures which resulted in close to 20 more cases per 1000 people over a 10-year period compared to people who ate meat. The biggest differences were for hip fractures, where the risk in vegans was 2.3 times higher than in people who ate meat, equivalent to 15 more cases per 1000 people over 10 years.”

Diet And Fracture Risk

Aside from the increase in hip fractures, vegans, vegetarians and pescatarians all had an increased risk of leg fractures compared to meat eaters, even when accounting for BMI (meat eaters more commonly had higher BMIs).

“This study showed that vegans, who on average had lower BMI as well as lower intakes of calcium and protein than meat eaters, had higher risks of fractures at several sites,” said Dr. Tong.

Now, that’s not to say that a non-meat diet should be avoided. Previous studies have shown that non-meat diets have been linked to a decreased risk of problems like heart disease and diabetes. However, this study shows that non-meat eaters need to put extra emphasis on eating nutrients that promote bone health, like calcium and Vitamin D. And if you’re a meat eater, you shouldn’t just assume you have great bone health because you’re getting nutrients from the meat. You also need to maintain a healthy BMI, otherwise those extra pounds you’re packing on will only put more stress on your bones.

To learn about other ways to prevent leg and ankle fractures, or to talk to a specialist about foot pain you’ve been dealing with, reach out to Dr. Silverman’s office today.

The post Are Vegans At Higher Risk For Leg And Ankle Fractures? appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

The injury occurred near the end of the group’s routine, which featured an energetic ensemble of rope and people jumping. As you can see in the video below, a few members of the group used a trampoline to launch over a human jump rope. One of the members got his left leg caught underneath him as he landed on the mat (2:40 of the clip).

http://www.youtube.com/watch?v=X8CnUvkzo7M

The injury was actually more severe than it looked on television. The performer fractured his tibia in three places, and he had to be taken to the hospital to be treated for his injury. Howie Mendell told viewers during the Wednesday’s results show that the performer was doing fine, despite needing crutches to get around.

Although he’ll need to rely on crutches for the foreseeable future, the performer played off the injury like a true professional. He finished the routine with a smile on his face, and he told host Nick Cannon that he felt “wonderful” and “couldn’t be better” after the performance.

“Of course, you have to stay strong for the audience,” the performer said when asked about battling through the pain. “I love America!”

Dr. Silverman comments

We have seen some bad injuries in the past get caught on live television over the last few months.

These Chicago Boyz are amazing. Unfortunately, the performer landed wrong, much like Louisville’s Kevin Ware. The energy of the performer’s injury was less than than Ware’s, and while his leg snapped, it didn’t go as far out of place.

A tibia fracture can be treated with or without surgery. With surgery, you can usually walk right away; without surgery, weight bearing is limited. Both heal well when the fracture is stable and minimally displaced. With displaced fractures or unstable ones, surgery does much better.

These types of fractures take 3-5 months to completely heal, so we won’t be seeing this acrobat for the remainder of America’s Got Talent.

I am impressed that he kept up the routine until the end. What an amazing pain tolerance he has. Best of luck healing.

Related source: NBC, WeLoveTVMore.com

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“He’s in a boot,” said manager Terry Collins. “They want him to do as little as possible for a while, let the mending start.”

d’Arnaud was catching for the Mets’ Triple-A affiliate when the injury occurred.  The club said the foul ball caused a non-displaced fracture of the first metatarsal in his left foot.

d’Arnaud was acquired in an offseason trade which sent 2012 N.L. Cy Young award winner R.A. Dickey to Toronto.  He is expected to be the catcher of the future for the Mets, but the team opted to have d’Arnaud start the season with the Las Vegas 51’s to get him some extra playing time.  The Mets are in no hurry to rush d’Arnaud to the big leagues, especially since their current catcher, John Buck, leads the majors in RBI and is second in home runs.

Dr. Silverman comments

What happened to Travis d’Arnaud?

He was struck by a baseball on his first metatarsal. This concentrated force caused a direct injury (contusion) to the skin, soft tissues and bone of his foot. The first metatarsal bone fractured from this energy of injury.

How is this injury treated?

In order for this to be treated non-surgically, the following two conditions must be present; the injury must be closed, (i.e. the skin must not have an open sore) and the fracture must be nondisplaced. Non-surgical treatment includes protected weight-bearing either with crutches or with a removable walking boot. It is very rare for a patient to be placed into a cast.

When is this treated surgically?

It’s treated surgically when there is an open injury, (ie. the force is so great that the skin splits) or if the bone becomes displaced and will not appropriately support weight in that position.

What happens in typical surgery?

In surgery, doctors will insert a few screws in order to squeeze bones together.  Plates, wires and absorbable pins may also be used. If the tissue injury is great, it’s not safe to put implants beneath the skin. Instead, external fixtures must be used.

How long does it take to heal?

It depends on the severity of injury and the handling of the rehab. If the injury is extremely damaging to the tissues by disrupting the blood supply to the bone, the fracture can take a very long time to heal. For this reason, fractures that occur from direct impact trauma and those that are the result of a crush injury take longer to heal.

How long will it take d’Arnaud to recover?

He should be healed by within 4-6 weeks. He’ll still want to ease his way back into the lineup when he feels strength returning to his foot.  Catcher is the most physically demanding position in baseball, and his feet need to support him in his crouch and when he moves laterally to block balls in the dirt.  If he were in the American League, he would benefit from the ability to ease back into the lineup as a designated hitter, but he doesn’t have that luxury in the National League.  I would expect to see him gradually returning to his normal role in about 8-10 weeks.

Related source:  Newsday

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“It’s not what we wanted, that’s for sure,” said manager Joe Girardi. “I know it’s extremely disappointing for him because he’s so used to being here with us.

Jeter had been working towards a return, as offseason reports said there was a possibility that he would be able to start Opening Day.  Jeter took part in five spring training games, but he wasn’t healthy enough to play full-time when the season started, so he stayed in Florida to continue his rehab.  After three straight days of workouts, Jeter went in for a routine check-up to determine how his ankle was healing.  Dr. Robert Andrews conducted a CT scan, which revealed a new crack in the bone.

“They did a new CT scan which revealed a small crack in the area of the previous injury, so we have to back off and let that heal,” said Yankees general manager Brian Cashman said. “This is obviously a setback. In terms of speculating on when we might see Derek back with us, we’d be looking at some time after the All-Star break.”

Two previous CT scans showed that the bone was healing properly, but the most recent scan revealed the new crack.

The new break will not require surgery, but doctors have advised Jeter to stop his rehabilitation exercises for four to eight weeks.  Doctors will continue to monitor the ankle, and oftentimes this injury heels properly as long as a patient refrains from strenuous activities.

“[The doctor] told me 95 percent of the people that have this, they come back from it fine. You just have to back off,” Cashman said.

The 13-time All Star will turn 39 in June, which leads some to believe that his rehab may take longer than the Yankees believe.

Dr. Silverman comments

The information coming out about Jeter is getting more interesting.

He underwent CT scans to confirm bone healing, two of which showed the bone was fully healed.  The new information indicates he had a true stress fracture of one of his ankle bones. But, if he had surgery to fix the fracture, and he had 100% healing on the last CT scan the following questions needs to be answered: Why did it break again, and why does it not need surgery this time?

Stress fractures happen for one simple reason: Mechanical overload to a bone that cannot compensate to the load fast enough.  Our bodies wear down each day as we take on weight-bearing activities. When you exercise, your body breaks down faster. When you have a mechanical disorder (high arch, flat foot, bow leg or unstable ankle or hindfoot) you break down even faster and in one specific area.  If your body breaks down is faster than it builds up, stress fractures occur.

Jeter’s fracture should not have recurred; something else is afoot. He was healed, but he is breaking down faster than he can build up, and the cause of the stress fracture needs to be addressed.

So, what types of things could be wrong with his ankle?

1.  Bone metabolism disorders: The most common disorder responsible for this is Vitamin D insufficiency. Vitamin D is actually a hormone that is produced with sun exposure. You need at least 60% of your body exposed for 20 minutes each day to produce enough Vitamin D. Is it possible that a Baseball player wearing long pants, long sleeves and a hat actually doesn’t get enough sun exposure? Yes.

2.  Ankle instability: Another common problem that causes a stress fracture is overload from ankle instability. Lateral ankle sprains are often viewed as innocuous in the history of a patient, but the lack of stability of the ankle can cause he medial (inner side) of the ankle to be excessively stressed. Not fixing the ankle instability surgically will result in recurrent fractures.

3.  Subtle hindfoot foot mal-alignment: A heel that is slightly twisted inwards can cause this problem (Think Grant Hill with his recurrent 5th metatarsal stress fracture and his heel varus)

The reassuring words coming from the article are fluff. He is out until the All-star break and somehow another three months of the same thing is going to make him better.  I would not be surprised if Jeter did not play again this year because he could easily suffer another setback.

Related source: AOL Sporting News

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TEREM Emergency Medical Centers operates five urgent care facilities and consults over 200,000 patients a year, including 10,000 fractures and 30,000 nonfracture injuries.  The medical center has round-the-clock computerized radiology, but they wanted to implement a system that would allow their orthopedists to provide consultations without getting on a computer or coming into the medical center.  Although they wanted to test smartphone technology, they did not want a patient to be misdiagnosed because the consultants were viewing the images on a small screen.

For their study, 41 sample images were taken from previous consultations.  The sample images featured everything from major fractures to minor conditions.  The images were sent to the orthopedists to be examined their smartphone.

In all 41 cases, each condition was successfully diagnosed by consultants using their smartphone.  To confirm their findings, each image was then reviewed using the medical center’s computerized imaging techniques.

Since the successful study, the TEREM medical center has reviewed an additional 312 images through smartphone technology.  As was the case with the study, all images were later confirmed using the center’s computerized imaging.  No clinically significant fracture has been missed in any of the 312 cases reviewed by mobile telephone.

The TEREM medical center has also found that their hospital referral rate has dropped significantly since the inception of smartphone consultation technology.  They reported a 50% drop in referrals from their clinics to hospitals because remote consultants were often able to provide medical advice to local clinics, which meant that patients could be treated without needing to visit an emergency room.  The medical center also reported increased comfort among their clinic physicians because they have greater access to specialized consultation through smartphone technology.

Dr. Silverman comments

I believe this was a great study, and I am pleased that the findings proved to be so successful.

In my line of work, there have been times where I have been asked to provide a consultation using only telephone conversation and limited radiology images.  Sometimes the images are sent through email, but I have also reviewed many images using only a smartphone.  I have been able to easily review radiographs and select MRI images through both the Android and iPhone platform.

I remember one specific incident where I reviewed a friend’s X-rays on my smartphone while I was on a plane.  He had fallen on while on vacation in Hawaii, and I was able to help him plan his care for the rest of the trip.

The prospect of smartphone imaging is exciting, but the finding that revealed a 50% drop in hospital referrals is also crucial.  Minor orthopedic injuries are an extremely common reason for emergency room referrals, which can be time consuming and put an extra burden on ER doctors.  Redirecting non-emergent problems to a clinic setting will save much needed time and money.  I look forward to this seeing this research applied in the United States.

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Researchers were granted permission to examine orthopaedic consultations in a trauma center for nearly two years.  They initially believed that post-splinting radiographs of acute non-displaced or minimally displaced fractures did not impact patient management or demonstrate changes in the fracture alignment, but they sought evidence to confirm their theory.

From September 2008 to April 2010 the level-1 trauma center had 1,321 consultations involving acute fractures that were splinted.  342 of those cases involved non-displaced or minimally displaced fractures, and 204 of those consultations were assessed with radiographs post-splint.

Of the 204 non-displaced or minimally displaced fractures, none of the radiographs revealed alignment changes after splinting.

Not only were an average of three post-splinting radiographs obtained for each individual, but the mean time between initial and post-splinting radiographs was three hours and thirty minutes.

The most common injury in the study was a hand/wrist fracture.  In these consultations, patients waited an average of nearly three hours for their post-splinting radiographs.  Not surprisingly, ER visits for patients with post-splinting radiographs tended to be longer than those without post-op radiographs.

In their conclusion, researchers noted that some circumstances require additional radiography, but additional imaging for non-displaced or minimally displaced fractures should be avoided to save time and money.

Dr. Silverman Comments

I have always felt that post-splinting radiographs were a complete waste of time and money.

In select cases, doctors are trained to take x-rays to prove they placed a cast on their patient, but in the above cases additional radiography provides no essential benefits.

I applaud these authors for their research and hope their work leads re-evaluation of radiography procedures in health care facilities.  Not only would it save money, but it would save children and adults from unnecessary radiation exposure.

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