Question

Chief Complaint: 75-year-old woman who fell on her left hip.

History: Judy Smith, a 75-year-old white female, was brought to the emergency room by her son after falling in her kitchen. She has had no major health problems in the past, but she has led an inactive lifestyle and has smoked cigarettes for over 40 years. Judy stated that she spilled water on the kitchen floor while making breakfast and forgot it was there, only minutes later to walk to the refrigerator and slip on the spilled water. When Judy fell, she landed on the left side of her body. She was given an injection to help relieve her pain and taken to the radiology department for an X-ray of her left leg and hip.

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

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

2. Draw a picture of what you think Margaret's fractured femur looks like.

4. Why do bones become osteoporotic in some people? (What, specifically, is happening in the bones themselves?)

During her long recovery, Margaret is advised by her physician to begin weight-bearing as soon as she can. To aid her in this regard, Margaret begins light physical therapy three times per week:

6. How does weight-bearing influence the bone healing process? (be detailed!)

7. In addition to the physical therapy benefits, why else might Margaret's physician want her to avoid prolonged bed-ridden activity?

Following her recovery, Margaret was placed on three medication: oral calcium supplements, oral estrogen and oral alendronate sodium (Fosamax). Fosamax is a drug which inhibits the activity of osteoclasts.

10. Specifically describe how each of these medications works to treat Margaret's condition.

Answer 1

PROXIMAL FEMUR FRACTURE (HIP FRACTURE) HIP → TRANSVERSE PROXIMAL FEMUR FRACTURE. > FEMUR (OF) THIGH BONE.

2)The above diagram showing the complete proximal femur fracture.

4) Osteoporosis is a condition in which the bones become thin and brittle.density becomes low.

Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption.The body may fail to form enough new bone or too much old bone may be reabsorbed.

lack of calcium and phosphate, lack of estrogen especially in menopausal women causes osteoporosis.Older age, being female are other most common causes of osteoporosis.

Answer 2

1. What is meant by a "complete, comminuted, intertrochanteric fracture of the right hip"?

complete: fracture completely through bone
comminuted: fracture in which bone shattered into several smaller pieces
intertrochanteric:fracture bw greater trochanter and lesser trochanter of the femur

3. The radiologist reported signs of osteoporosis. Describe the characteristics of an osteoporotic femur as seen on an X-ray. (How does it differ in appearance from a normal femur?)

loss of spongy bone
thinning of outer layer of compact bone.
loss of cancellous bone in proximal and distal epiphyses

4. Describe the microscopic features of osseous tissue that normally help long bones withstand lateral stress without breaking.

causes compression of the bone on the side of impact and stretching on the side opposite of the impact

5. Describe the microscopic features of osseous tissue that normally help long bones withstand compressive stress without breaking.

interlocking network of bony plates found in spongy bone help distribute weight of body to tough bony collar of the diaphysis.

6. Describe the changes that a broken bone undergoes as it is healing.

1. blood clot forms
2. soft tissue callus
3. body callus
4. bone remodeling

7. During her long recovery, Margaret is advised by her physician to begin weight-bearing as soon as she can. How does weight-bearing influence the process you described in question #6? (Be specific in your answer and describe what weight-bearing does to bone at the microscopic level.)

Wolff's law states that bone grows and remodels in response to the mechanical stresses placed upon it. Thus, bone is laid down along lines of maximal stress.