May 2014 Vol. 2 No. 5

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Review

Loss of autonomic postural reflexes, Gait abnormalities and "freezing walk” in severe Parkinson’s disease Patients contributes to falls and hip fractures

¹Yassin Mustafa M. D., ²Khatib Muhammad M. D., ³Garti Avraham M. D., ⁴Saffuri Husam M. D. ⁵Nibal Abu-Ahmad and ⁵*Prof. Dr. Bowirrat Abdalla M. D., Ph.D
 

¹Head of the Joint Replacement Unit, Department of Orthopaedic, Rabin Medical Center, Campus Hasharon, Israel.
²Department of Orthopaedic, Rabin Medical Center, Campus Hasharon, Israel.
³Rabin Medical Center, Head of the Department of Orthopaedic, Campus Hasharon, Israel.
⁴Head of Shoulder Surgery Unit, Department of Orthopaedic, Holy Family Hospital, Nazareth
⁵EMMS Nazareth Hospital, Nazareth, Zip code: 16100, Israel
5*Professor of Clinical Neuroscience and Population Genetics, EMMS Nazareth Hospital, Nazareth, Zip code: 16100, Israel.

*Corresponding Author's E-mail: bowirrat@gmail.com; Tel: +972 4635-6133; Fax: +972 4602-8882

Accepted May 13, 2014
 

Abstract

Since the average of life expectancy continues to ascend, the number of elderly people increases remarkably. Simultaneously, musculoskeletal diseases including PD and related disorders rise. Hip fractures, particularly in PD patients, should not be viewed as a routine public health concern that need orthopedic intervention only, but it is a challenge with consequences that override the orthopedic problem. The aim of this manuscript is to shed light and to try to identify the underlying causes of and circumstances surrounding the fall and hip fractures in Parkinson's disease (PD) patients, in order to find prevention strategies and choose appropriate therapy. We have analyzed, discussed and overviewed the latest updates of the medical literature concerning PD and the orthopedic complications. PD is a chronic neurodegenerative disorder characterized by rest tremor, rigidity, bradykinesia and loss of postural reflexes, leading to immobility and gait disturbance. The usual age of onset is between the sixth and eighth decades. Globally, the percentage of elderly aged 65 years and over was calculated to be 8 percent (521 million) in 2011 and it is expected to be 11 percent (939 million) of the total global population by 2030. Hip fractures are life-threatening and frustrated quandary that is usually seen among elderly people that requires high economic expenses. Plethora of factors contributes to falls and to increased risk of hip fractures in patients with PD. These factors include potential physiological aging changes and medical causes. One should try to identify the underlying causes of and circumstances surrounding the fall and hip fractures in PD patients specifically, in order to find prevention strategies and choose appropriate therapy by taking a multidisciplinary approach interventions that include neurologist, physiatrist, podiatrist, and family or caregivers the thing that will result in optimal outcomes for patients with PD.

Keywords: Parkinson’ disease, Postural instability, Falls, Hip fractures, Prevention