Hand Dominance and Walking Aid Use - Pre-determinants for Hip Fracture in the Elderly?
AIM: Left handedness has previously been associated with an increased risk of fracture for a number of sites but to the best of our knowledge no association between handedness and hip fracture has previously been reported.
MATERIALS AND METHODS: Two separate 6-month prospective reviews of hip fracture patients aged over 65 years of age were conducted at two different hospitals, with the second review focusing on walking aid use. The patients with a neurological condition or contralateral hip prosthesis were excluded due to increased balance problems and falls risk.
RESULTS: Hand dominance was recorded for 339 patients; 304 right and 35 left. A total of 91 patients were excluded from the study. Of the remaining 248 patients, 2.06 times as many fractured their hip on the side of their non-dominant hand. For the left-handed individuals this increased to 4.6 times. Walking aid use was recorded for 102 patients. Equal numbers of the right and left hip fractures were sustained for patients using no walking aids, a Zimmer frame or two walking sticks; while 97.7% of patients using one walking stick did so in their dominant hand, sustaining 84% contralateral hip fractures.
CONCLUSION: The direction in which people fall and the causes of hip fractures is clearly multifactorial. However, we did find an association between hand dominance and hip fracture, especially when using a single walking aid. By being aware of this association, it may be possible to target both patient education and physiotherapy potentially reducing the number of patient falls and associated hip fractures.
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National Institute for Health and Care Excellence Guidance. Hip Fracture. Costing Report. Implementing NICE Guidance. NICE Clinical Guideline 124; 2017. Available from: https://www.nice. org.uk/guidance/cg124/evidence/full-guideline-pdf-183081997. [Last accessed on 2019 May 20]. https://doi.org/10.21037/ tau.2017.05.21
White SM, Griffiths R. Projected incidence of proximal femoral fracture in England: A report from the NHS hip fracture anaesthesia network (HIPFAN). Injury. 2011;42(11):1230-3. https://doi.org/10.1016/j.injury.2010.11.010 PMid:21183180
Rudolph V. Predominance of left-sided fractures of the proximal femur in a geriatric population. Orthopedics. 1994;17(7):601-2. PMid:7937374
Has B, Nagy A, Has-SchÃ¶n E, PaviÄ‡ R, Kristek J, Splavski B. Influence of instability and muscular weakness in ethiopathogenesis of hip fractures. Coll Antropol. 2006;30(4):823-7. PMid:17243557
Dane S, Akar S, Hacibeyoglu I, Varoglu E. Differences between right-and left-femoral bone mineral densities in right-and left-handed men and women. Int J Neurosci. 2001;111(3-4):187-92. https://doi.org/10.3109/00207450108994230 PMid:11912674
Canakci V, AkgÃ¼l HM, AkgÃ¼l N, Canakci CF. Prevalence and handedness correlates of traumatic injuries to the permanent incisors in 13-17-year-old adolescents in Erzurum, Turkey. Dent Traumatol. 2003;19(5):248-54. https://doi. org/10.1034/j.1600-9657.2003.00199.x PMid:14708648
Hemenway D, Azrael DR, Rimm EB, Feskanich D, Willett WC. Risk factors for wrist fracture: Effect of age, cigarettes, alcohol, body height, relative weight, and handedness on the risk for distal forearm fractures in men. Am J Epidemiol. 1994; 140(4):361-7. https://doi.org/10.1093/oxfordjournals.aje.a117258 PMid:8059771
Luetters CM, Kelsey JL, Keegan TH, Quesenberry CP, Sidney S. Left-handedness as a risk factor for fractures. Osteoporos Int. 2003;14(11):918-22. https://doi.org/10.1007/ s00198-003-1450-z PMid:14530828
Sung PS, Spratt KF, Wilder DG. A possible methodological flaw in comparing dominant and nondominant sided lumbar spine muscle responses without simultaneously considering hand dominance. Spine (Phila Pa 1976). 2004;29(17):1914-22. https://doi.org/10.1097/01.brs.0000137071.47606.19 PMid:15534417
Seddon BM, McManus IC. The Incidence of Left-handedness: A Meta-analysis. Unpublished Manuscript. London: University College; 1993. Available from: http://www.cnmd. ac.uk/medical-education/reprints/1993seddon_mcmanus-unpublishedmetaanalysis-minorcorrectionsfeb2005.pdf. [Last accessed on 20 May 2019].
Hardyck C, Petrinovich LF. Left-handedness. Psychol Bull. 1977;84(3):385-404. https://doi.org/10.1037/0033-2909.84.3.385
Sahin A, Dane S, Seven B, Akar S, Yildirim S. Differences by sex and handedness in right and left femur bone mineral densities. Percept Mot Skills. 2009;109(3):824-30. https://doi.org/10.2466/ pms.109.3.824-830 PMid:20178282
GÃ¼mÃ¼ÅŸtekin K, Akar S, Dane S, Yildirim M, Seven B, Varoglu E. Handedness and bilateral femoral bone densities in men and women. Int J Neurosci. 2004;114(12):1533-47. https://doi. org/10.1080/00207450490509186 PMid:15512837
Leetun DT, Ireland ML, Wilson JD, Ballantyne BT, Davis IM. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc. 2004;36(6):926-34. https:// doi.org/10.1249/01.mss.0000128145.75199.c3 PMid:15179160
Gusi N, Adsuar JC, Corzo H, Pozo-Cruz BD, Olivares PR, Parraca JA. Balance training reduces fear of falling and improves dynamic balance and isometric strength in institutionalised older people: A randomised trial. J Physiother. 2012;58(2):97-104. https://doi.org/10.1016/s1836-9553(12)70089-9 PMid:22613239
Lacroix A, Kressig RW, Muehlbauer T, Gschwind YJ, Pfenninger B, Bruegger O, et al. Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: A randomized controlled trial. Gerontology. 2016;62(3):275-88. https://doi.org/10.1159/000442087 PMid:26645282
Ko DS, Jung DI, Jeong MA. Analysis of core stability exercise effect on the physical and psychological function of elderly women vulnerable to falls during obstacle negotiation. J Phys Ther Sci. 2014;26(11):1697-700. https://doi.org/10.1589/ jpts.26.1697 PMid:25435680
Shepherd AJ. Incorrect use of walking aids in patients with hip pathology. Hip Int. 2005;15(1):52-4. https://doi.org/10.5301/ hip.2008.3980 PMid:28224583
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