Case Study Femur Fracture PDF

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This is my answer to a case study regarding a fractured femur. ...

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Case History 6: Osteoporosis

THIS IS FOR STUDY PURPOSES ONLY – I would love to be an extra help, but this is NOT meant to be taken and used as your own lab! 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"? A complete fracture is one where the bone in question is completely separated into 2+ pieces, the bone is not simply cut into. In this case, the bone is fractured in multiple, irregular shaped pieces, because it is a comminuted fracture. The fact that it is intertrochanteric gives us the location. Trochanters are found on the proximal portion of the femur, and “inter” indicates “between”, so the shattering occurred near the neck of the femur, between the trochanters. 2. Draw a picture of what you think Margaret's fracture looks like. Please see additional attachment, as I was not able to add the pdf of my scanned, hand-drawn picture to the docx file

Case History 6: Osteoporosis

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?) The most obvious sign of osteoporosis is that the already “spongy” looking cancellous bone looks even more porous. A major function of bone is fat and mineral storage, so osteoclasts are continually breaking down the bone to redistribute the needed materials to the blood stream. A healthy bone will also be rebuilding that bone (the job of osteoblasts), however the osteoblasts cannot keep up with the rebuilding in osteoporotic bones, so the bones become brittle and fragile. The compact bone in the femur can also be affected, as minerals are part of what make bones so strong, so its demineralization leaves it fragile. 4. Describe the microscopic features of osseous tissue that normally help long bones withstand lateral stress without breaking. AND 5. Describe the microscopic features of osseous tissue that normally help long bones withstand compressive stress without breaking. There are several mechanisms by which healthy long bones can withstand great pressure, such as mineral calcification, the cylinder-like orientation of osteons, and the trabecular orientation along stress line, the latter particularly protecting against compressive stress. In addition to these, the long bone is protected by hydroxyapatite crystals within osteons which are like vertical columns within the bone. 6. removed due to incomplete question 7. Describe the changes that a broken bone undergoes as it is healing. First, blood clot to stop the blood flow from vessels torn in the fracture. Around the first week this clotting forms a whole “fracture hematoma” around the fracture and surrounding bone. Weeks 2-3, cartilage-based procallus is formed along the fracture. Osteoblasts then form callus tissue (like an organic glue) which binds the edges of the fracture together. It is like a chaotic, boney, spackling job, and the excess gets broken back down and reabsorbed. This callus “spackle” job can take 12 weeks, and the bone is typically repaired at around 4 months. 8. During her long recovery, Margaret is advised by her physician to begin weightbearing 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.) Bone growth occurs in response to stress placed on it. The amount of strain put on a bone while exercising could seem detrimental, while it is actually the thing that triggers more collagen fibers to be constructed, reenforcing the bone. 9. What risk factors does Margaret have for osteoporosis? Margaret is female, Caucasian, and in an older age bracket (all of which are risk factors). The medical history also states that she had a fairly sedentary lifestyle, which would not trigger the growth of protective collagen fibers. Smoking also enhances risk. 10. What parts of the skeleton (i.e. what bones) are most vulnerable to the ravages of osteoporosis? The hip, the wrist, and the spine (Femur, carpals, and vertebral column).

Case History 6: Osteoporosis

Part B Assessments 11. Match the terms in column A with the definitions in column B. Place the letter of your choice in the space provided. Column A

__c____ 1. Small, nearly flat articular surface

a. Condyle b. Crest

___e___ 2. Deep depression or shallow basin

c. Facet

__a___ 3. Rounded process

d. Foramen

____d__ 4. Opening or hole

e. Fossa

___g___ 5. Projection extension

f. Line

___b___ 6. Ridgelike projection

g. Ramus

____f__ 7. Slightly raised ridge

Column B...