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24 Cards in this Set
- Front
- Back
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What is the WHO definition for osteoporosis?
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- Bone mineral density >=2.5 standard deviations below the mean seen in young normal subjects
- decreased bone density with normal bone mineralization |
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Risk Factors for Osteoporosis
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- Females
- European Ancestry - Sedentary lifestyle - Multiple births - Excessive alcohol use |
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What are the most common fractures in the elderly osteoporotic patient?
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- Hip
- Proximal humerus - Distal radius - Ankle - Vertebral compression |
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Problems with osteopenia?
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- complicates fracture treatment and healing
- Internal fixation compromised (screw can pull out) - Increased risk of nonunion |
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Importance of Cognitive status in elderly patients with fractures
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- Critical to outcome
- Conditions may render patient unable to participate in rehab (Alzheimers, CVA, Parkinsons, Senile Dementia) |
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What are the risk factors for hip fractures?
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- Elderly: poor balance, vision, inactivity, medications, malnutrition
- osteoporosis - caucasian - Smokers, small body size, excess caffeine & alcohol - Young: High energy trauma - greatest after 50 years - Female/ Male 2:1 |
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What is the most common hip fracture?
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Femoral neck and intertrochanteric fractures
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What x-rays should be ordered to diagnose a hip fracture?
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- AP
- Cross table lateral - Internal rotation will help delineate fracture pattern |
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Occult hip fracture imaging
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- Need Bone scanning after 2 to 3 days
- MRI can be performed in 24 hours |
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Treatment for Hip Fracture
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1) Prompt operative stablization (every 24 to 48 hours- one year taken off life)
2) Early mobilization 3) DVT prophylaxis |
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Femoral Neck Hip Fractures
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- blood supply cut off to intracapsular mostly from ascending arteries
Treatment: Nondisplaced- nonoperative or surgery with cannulated screws Displaced- Operate Hemiarthroplasy- can lead to acetabular erosion MOBILIZE EARLY |
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Intertrochanteric Hip Fractures
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- Region distal to the neck between the trochanters
- well vascularized - important muscle insertions |
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Treatment for Intertochanteric Hip Fractures
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- Usually treat surgically
- implant (good for weight bearing) - primary prosthetic replacement (comminution) |
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Subtrochanteric Fractures
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- begins at or below the level of the lesser trochanter
- typically higher energy injuries seen in younger patients - less common in elderly |
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Treatment for Subtrochanteric Fractures
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- Intramedullary nail
- plates and screws |
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What is the hip fracture seen in younger people?
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Subtrochanteric Fractures
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What population gets vertebral compression fractures?
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- All post-menopausal women over age 70
2x as common in females |
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What is the most common Vertebral compression fracture?
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between T8 and L2
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What indicates a vertebral compression fracture?
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- kyphosis and scoliosis
- Acute back pain - Tender to palpation Patterns: - Biconcave (upper lumbar) - Anterior Wedge (thoracic) - Symmetric Compression (thoracic lumbar junction) |
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What images are needed for a vertebral compression fracture?
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X-RAY
- AP spine - Lateral spine - symptomatic vertebrae will be 1/3 height of adjacent Bone Scan - Differentiates old from new fractures |
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Treatment for Vertebral Compression Fractures
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- Simple- treated nonoperatively and symptomatically
- Avoid prolonged bed rest - Progressive ambulation should be started early - Back exercises started after few weeks - Corset may be helpful - Kyphoplasty is an option |
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How to prevent Vertebral Compression Fractures?
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- control factors that could cause falling
- medical adjustment - behavior modification - Exercise classes - Prevention is MULTIFACETED |
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What is a joint effort between orthopedics, primary care physicians, PT and social work?
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Cost containment
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Treatment of Osteoporosis
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Estrogen
Calcium/ Vitamin D Calcitonin Biphosphates Teriparatide |
