Do folks get checkups after every fall?

[faji_tama]

I'm curious what the recommended practice is, or what folks usually do, after experiencing a fall (either out of their chairs, or while transferring) if there's nothing visibly wrong? I don't think it's really feasible to get a full set of x-rays and scans every time you fall to check for fractures or dislocation, but in the absence of our ability to feel pain, or any other symptoms like AD or swelling/bruising, what should we do?

[triumph]

My husband slid almost out of his wheelchair after a transfer when I was hospitalized for a month. He came in the morning of this fall to visit me and told me about having to call 911 and waiting 15 minutes or so for help. I was alarmed but he seemed to think things were ok, no spasms or anything.
About 5 weeks after I was home and life was back to normal, he found a wetness near his back/ribcage area where he couldn't see with his mirror and asked me to check it. What a shock - it was a stage 3 sore about 1 3/4 inches wide by about 1" tall. We were able to get help the same day -they said it was stage 3 and set up appointment at wound clinic.
I guess the moral of the story is to visibly check all areas after a fall - and I would suggest asking the nurse here for any recommendations. My husband felt ok and never checked even visibly. Lesson learned!

[Kulea]

If I was able to get back into my chair, then I never went in. Of course you check over your body carefully and MONITOR. Any signs of redness or swelling, and monitor closer. For me, when I broke a leg, the swelling didn't start for a couple days, but then it didn't stop, kept getting more and more swollen. The doctor says the fluid is basically leaking out of the bone and won't stop until the bone starts healing. So, once you get the swelling, definitely go in and insist on xrays, because they may think it is just a surface thing (cellulitis). Sometimes, they can't believe you wouldn't feel a bone break, so they dismiss it. Also, make sure they cover a broad area with the xray, cause I had it where they only xray my ankle (the greatest swelling), when the break was further up. Luckily it was barley visible on the corner of the xray. I broke the other leg 2 years later. Doc says that I have to be VERY careful now (37 years post) because my legs are just brittle. I never used to worry about falls or being active. Anyway, other than swelling, I didn't experience any other symptoms, no AD, no spasms upon touching the area. The first time, I was just shocked that it was such a major break, as everything seemed normal. I only went in after a week of swelling, when fluid was starting to seep out of my pores and I had cellulitis forming.

But in answer to your question, until you get to the stage where your bones are brittle, then they shouldn't break from a non-violent fall. And, soft tissue damage isn't something most docs would be able to diagnose or care much about, since you don't feel pain or use the joint. So, if you don't have skin damage, or bruising/discoloration that gets worse, or swelling, then I wouldn't be too concerned.

[faji_tama]

What a shock - it was a stage 3 sore about 1 3/4 inches wide by about 1" tall. We were able to get help the same day -they said it was stage 3 and set up appointment at wound clinic.
I guess the moral of the story is to visibly check all areas after a fall - and I would suggest asking the nurse here for any recommendations. My husband felt ok and never checked even visibly. Lesson learned!

Oh no! I'm guessing it was a bruise that he missed that turned into a pressure sore? I definitely make a point of checking all over whenever I fall though (and mornings in general, actually).

But in answer to your question, until you get to the stage where your bones are brittle, then they shouldn't break from a non-violent fall. And, soft tissue damage isn't something most docs would be able to diagnose or care much about, since you don't feel pain or use the joint. So, if you don't have skin damage, or bruising/discoloration that gets worse, or swelling, then I wouldn't be too concerned.

Ah, I'm actually 31 years post myself, and have already broken my left leg three times over the past two decades, so not made of the stronger stuff myself either. Though, admittedly they were all from somewhat higher impact events. Recent DXA scans that I finally did show that I have osteopenia, which probably isn't really a surprise either. The prior breaks I was all fairly aware of because I either heard something snap or because of bone grinding I heard while moving around after, and I've generally noticed minor swelling pick up within a few hours of the breaks that get a bit worse as the days go on. That said, I've never really thought about hip fractures or dislocations and how those might present though, which are more a concern when I flip backwards out of my chair and land butt first (rather than catching myself).

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This is actually probably a better question for the the nurses though: I know bruising, AD, etc are not guarantees, but would we expect to always see swelling associated with fractures (including minor hairline/stress fractures) and dislocations? With a hip dislocation, I imagine they're pretty noticeable as well, and odd angles and deformities aside, you'd have decreased range of motion of your limbs as well, right?

[triumph]

Are all the broken bones mentioned here from transfers?

Reminds me of something I heard recently: "We are all one transfer away from falling".

[crags]

The foot rests of my power chair hit a dresser several years ago though I was unsure as to whether it affected my lower extremities from the mid-tibia on down. I had shoes on but apparently my foot had rode under the dresser and the hard edge must have caught my ankle in just a strange manner. The next day it was hot red and swollen. Not putting two and two together I saw my primary care physician and another physician who both, not unreasonably, suspected cellulitis, which I incidentally had three episodes in the same ankle several years later. After taking antibiotic and see no response I went to the ER and had it x-rayed, upon which they found nondisplaced fractures of the medial malleolus and fibula. Thank God I didn't ambulate and it didn't involve anything higher because I was able to use a removable ankle brace/soft cast and sit properly.

The point is, any trauma involving a force upon our bodies, needs to be treated seriously which results in observable changes and quite possibly even if there are no observable changes, since hairline fractures can worsen into more serious problems.

I'm 32 years post C7 quadriplegia with shoulder, hand and elbow problems, as well as frequent very substantial morning dizziness. It was probably only a matter of time before I took a major fall with all of the consequences that entails.

While I do not like increased dependence such as the Surehands lift, it has made life a lot safer and also has the benefit of preserving what is left of damaged upper extremity joints.