RESUMEN
PURPOSE: To determine the threshold Berg Balance Scale (BBS) scores that discriminate among levels of gait-aid use in elderly subjects. METHODS: A secondary analysis of data combined from two projects was performed. Both projects determined BBS performance, self-selected gait speed, and gait-aid use in samples of community-dwelling, independently ambulant individuals older than 65 years of age. Receiver operating characteristic curves were used to identify BBS scores that optimized identification of individuals with different levels of ambulation. RESULTS: Previously determined associations between BBS score and various indicators of ambulatory ability were reproduced with the combined data set. Threshold BBS scores were identified for ability to walk without an aid (≥49/56) and ability to walk without a four-wheeled walker (≥43/56). The percent agreement values for the identified threshold scores ranged from 51% to 87%. CONCLUSIONS: Although some threshold BBS scores could be determined, the accuracies of the scores render them of limited use for guiding gait-aid prescription in individual clients.
RESUMEN
The authors have performed a retrospective study of 8 patients, all elderly females, seen in the period 2002-2004 with insufficiency fractures of the tibial plateau. Their mean age was 74 years (range 70-84). There was a history of trivial trauma in all patients, except one. Three of the patients were referred to the orthopaedic department, as a fracture line was visible on the plain radiographs taken 3 to 6 weeks after the trauma. The remaining five patients presented immediately after the trauma, which explains why their radiographs were still negative or only showed osteoarthritis. In the same 5 patients a diagnosis of tibial plateau fracture was made by CT-scan in 3, and by MRI-scan in 2 patients. All patients except one had a DEXA-scan, which revealed osteopenia in 4 and osteoporosis in 3 patients; all 7 were treated with bisphosphonates. All 8 patients were treated conservatively with a cast brace, for 6 to 12 weeks, with a good result. Insufficiency fracture of the tibial plateau is an often missed diagnosis. Plain radiographs are frequently negative in the beginning. Delayed diagnosis can cause pain and disability to the patient and can lead to deformity of the knee joint, due to structural collapse. MRI is sensitive to bone marrow oedema/ bone bruising, even in the osteoporotic tibial condyle. Once the diagnosis is made, the results are good with non-operative treatment.
