Question

Mary-Lou’s family was happy with the management plan established by the doctor as Mary-Lou was progressing quite well. She was using notepads to jot down reminders, a pillbox to keep her medication organized and a calendar to record appointments. Her family members were helping her with routine tasks such as cooking and paying bills. She was feeling much happier and did not have to rely on alcohol to go to sleep. On one particular day she was feeling so good she decided to walk to her GP appointment alone. On her way there she stumbled over a branch and fell. She felt excruciating pain in her hip. A passer-by called an ambulance and she was taken to the emergency department at the Royal Melbourne hospital. An X-ray revealed that she had broken the neck of her femur and had to have surgery to repair it. Mary-Lou wondered whether this was linked to the crepitus she had been experiencing in her joints. Her joints did feel quite stiff and painful lately. The specialist explained to Mary-Lou that the crepitus was likely due to degeneration of her cartilage and said that the fracture might have been due to weakened bones. He told her he would like her to have a bone mineral density test to measure her bone density. The DEXA scan gave a T-score of -3.0. Mary-Lou is now given bisphosphonates and told to increase her daily intake of calcium.

Q.Discuss why Mary-Lou’s fracture may take longer to heal than it would for someone who was half her age. In your answer, you are expected to name and discuss three physiological factors that are needed for healing to take place and explain how each of the factors you identified is affected by aging. Finally, name two complications of hip fracture that are prevalent in the elderly

could you please answer the given question for the above case study.

thank you...

Answer 1

As shown in the question patients DEXA score is 3.0 therefore according to DEXA score :

T-score of -1.0 or above =normal bone density. T-score between -1.0 and -2.5 = low bone density, or osteopenia. T-score of -2.5 or lower = osteoporosis.

patient is suspected of osteoporosis in which bone become weak and brittle and can break easily needs more time to heal up because In this condition new bone creation doesn't keep up with old bone removal.

3 physiological factors are:

anemia: iron-deficient anaemic humans have deficiencies in bone healing, with a decrease in the rate of union and loss of strength. There is poor mineralisation of the callus. The changes have been attributed to a decrease in oxygen tension and a deficiency of iron, which is required for function of the electron transport system within the cell and for hydroxylation of proline in collagen formation.impairment  of wound healing in soft tissue has been observed secondary to anaemia because of acute blood loss without maintenance of blood volume.

Malnutrition: Nutritional and metabolic requirements increase during fracture repair. vitamin B6-deficiency caused a significant delay in the maturation of callus. Vitamin C is essential for the maintenance of differentiated functions of osteoblasts, including that in fracture repair.

Peripheral vascular disease: Peripheral vascular disease adversely affects the blood flow to the tissues, including the bone and the surrounding soft-tissue envelope. This will impair delivery of oxygen, inflammatory cells and nutrients to the fracture site. There will be a build up of carbon dioxide (CO2) and other metabolites rendering the local environment acidic. This combination of factors is likely to be detrimental to fracture repair.

complication of hip fracture are:

Serious complications can result from a hip fracture. A patient may have to remain in traction for a specified period of time after surgery. Blood clots can occur in the veins, usually in the legs. If a clot breaks off, it can travel to a blood vessel in the lung. This blockage, called a pulmonary embolism, can be fatal.

Other complications can include:

• Pneumonia
• Muscle atrophy (wasting of muscle tissue)
• Post-operative infection
• Non-union or improper union of the bone
• Mental deterioration following surgery in older patients
• Bedsores from lying in the same position with minimal movement

With some fractures, blood cannot circulate properly to the femoral head, resulting in a loss of blood supply to this area. This is called femoral vascular necrosis or avascular necrosis. This complication may occur depending on the type of fracture and the anatomy of a person's blood supply to the head of the femur bone. This is more common with femoral neck fractures.