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.

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 ageing. Finally, name two complications of hip fracture that are prevalent in the elderly. .

Answer 1

Age effect on fracture healing:

a. Aging affect inflammatory responses during fracture healing. Cells of inflammatory response, macrophages, T- cells, mesenchymal stem cells, have demonstrated intrinsic age related changes that impact healing.

b. Vascularization and angiogenesis are impaired in fracture healing of the elderly.

c. Osteochondral cells and their progenitors demonstrate decrease activity and quantity.

Physiological factors needed for healing:

a. Early healing stage is characterized by inflammatory response that is responsible for debriding the fracture site and contributing to the signalling milieu.

b. A hard callus begin to develop through endochondral ossification with increased mineralisation and replacement of chondrocytes with osteoblasts. It decreases with age.

c. Muscle stem cells ( satellite cells) may comprise the skeletal tissue. It's quantity and function decline as age increases.

Complications of hip fracture:

Immobility for a long time leads to--- blood clots in legs, bedsores, UTIs, etc.