Observation of vestibular asymmetry in a majority of patients over 50 years with fall-related wrist fractures

Previously [The abstract has been shortened somewhat, and the headings remo ved, in order to conform to journal style], we have observed vestibular asy mmetry in about one-third of healthy senior citizens and in about two-third s of subjects with previous hip fractures and no other significant ailments . Wrist fractures are considered a harbinger of hip fractures. If vestibula r asymmetry is correlated with falls and fractures among the elderly then i t should also be reflected among subjects with wrist fractures, Sixty-six c onsecutive patients (mean age 67.8 years) who had sustained a fall-related wrist fracture during a 10-month period were included in the study. The fre quency of head shake nystagmus among the patients was compared to that foun d among 49 healthy senior citizens (mean age 74.9 years). Nystagmus after h ead shaking, indicating asymmetric vestibular function, was found in 50 par ticipants (76%) (p < 0.001). Thirty-eight of these were graded with distinc t or prominent nystagmus responses. Sixty percent of the subjects with hori zontal nystagmus had a wrist fracture coinciding with the slow phase of nys tagmus. Twenty-three subjects reported 30 previous fall-related fractures d uring the previous 10 years, Subjects with nystagmus after head shaking sus tained 26 of these fractures. The frequency of signs of vestibular asymmetr y was significantly higher (p < 0.001) among the subjects than among health y senior citizens. These findings suggest that an asymmetric vestibular fun ction could be an epidemiologically important contributory factor to falls and wrist fractures among the elderly population.