Question

Chief Complaint: 72-year-old woman who fell on her right hip.

History: Margaret Donovan, a 72-year-old white female, was brought to the emergency room by her son-in-law after falling in her bathtub. She was previously in good health, despite leading a relatively sedentary lifestyle and having a 30-pack-year history of cigarette smoking. The only medication she currently takes is Inderal (propranolol) for mild hypertension. She fell upon entering the bathtub when her right leg slipped out from under her; she landed on her right hip. There was no trauma to her head, nor does she complain of right or left wrist pain. However, she reports severe pain in the right hip and upper thigh, and was unable to get up after her fall. An injection of oxymorphone hydrochloride (Numorphan) helped relieve her pain and she was taken to the radiology department for an X-ray of her right leg and hip.

Physical Examination: The patient was alert, oriented to time, place, and date, and was responding appropriately to questions despite being in considerable pain. There were no signs of trauma to the head, neck, torso, arms, or left leg. The right thigh and hip were extremely tender and were immobilized by a leg splint. Heart and lung sounds were normal, and abdominal sounds were reduced.

Radiology Report: The X-ray of the right hip revealed a complete, comminuted, intertrochanteric fracture of the right hip. No other fractures were noted in the right leg. There were also long-term osteoporotic changes in the femur, tibia, and fibula.

Questions:

1. What is meant by a “complete, comminuted, intertrochanteric fracture of the right hip”
2. The radiologist reported signs of osteoporosis. Describe the characteristics of an osteoporotic femur as seen on an X-ray (How does this differ in appearance from a normal fracture)

Treatment: Surgeons performed an open reduction of Margaret’s fracture, immobilizing the bones with internal pins

Questions:

3. Aside from any effect on the healing process, why else might Margaret’s physician want her to avoid a prolonged period of bed-ridden inactivity?
4. What risk factors does Margaret have for osteoporosis?
5. What parts of the skeleton (ie what bones) are most vulnerable to the ravages of osteoporosis?
6. Following her recovery, Margaret was placed on three medications: A) oral calcium supplementation, B) oral estrogen, and C) oral alendronate sodium (Fosamax). Specifically describe how each of these mediations works to treat Margaret’s condition.
7. Other treatments for osteoporosis include A) sodium fluoride and B) calcitonin. Describe how each of these medications works to treat osteoporosis

Answer 1

1. Complete, comminuted, intertrochanteric fracture of the right hip.

  A fracture may be complete or partial. Complete means the fracture is completely through the bone without any remaining attachment. A comminuted fracture is a type of fracture resulting in numerous pieces of broken bones Intertrochanteric fracture means extracapsular fractures of the proximal femur located in the metaphyseal bone-in the region  between the greater and lesser trochanter  

A complete fracture of the proximal femur in the region between the greater and lesser trochanters into numerous pieces.

2.

Radiographic features of osteoporosis include

1. decreased cortical thickness, denotes the Decreased bone density

2 Loss of bony trabeculae.

Radiographic features of a fracture

Radiolucent lines between the fractured bone segments which on approximation will configure the original shape.

Bone density and trabeculae appear normal.

3. Aside from any effect on the healing process, why else might Margaret’s physician want her to avoid a prolonged period of bed-ridden inactivity?

This is patient is reported to have osteoporosis and hypertension. prolonged bedridden may worsen the condition

4. What risk factors does Margaret have for osteoporosis?

Includes.

• further healing,
• malunion of the fracture

5. What parts of the skeleton (ie what bones) are most vulnerable to the ravages of osteoporosis?

• The femur at the hip;
• ·The vertebrae of the spine; and.
• · The wrist.