CSI CASE 6 Flashcards
What are some risk factors for falls?
neurological - depression, confusion, congenititve impariment, poor balance
unmodifiable - age, female, history of falls
chemcial- drugs side effects, polypharmacy (concurrent use of multiple medication)
cardiovascular - orhostatic hypotension (low bp after sitting long), arrthyrmia
neurmusclar - gait disorders e.g parkinsons, muscle weakness, pheripheral neruoahtpy
enviroment at home
what are fragility fractures?
from mechanical forces wouldn’t normall result in fracture. - low level trayma
What are common places for fragility fractures?
vertebrae, hip (promxial femur), wrist (distal radius)
What is a cause factor for fragility fractures?
reduced bone mineral density - seen in osteoporis
also other causes: osteogensis imperfecta, acrogemally, inflam arthrieites, curshin’s syndrone
What is osteoporsis?
reduction in bone mineral denisty, liable to fracture
How is OP diagnosed?
dexa scan - determination of bone mass at skeletal locations
comapre to sex and age, T SCORE
smaller than -2.5
What is pathiopgsyology of OP?
osteoclast activity > osteoblast activity
results sequneital trabecular loss
what are causes of osteoporisis?
has to do with PTH, calincontin, Ca2+, ostrogen
age - less Ca2+ and Vit D
female - loss of oestrogen as ostrogen usually stimulates oestoblast activity and inbits osteoclasts
what are clincal signs of OP?
trabecualae in cancellous bone reduced
cortial bone osteons thinning and havasian canal widening - reduction strength
What are 2 components of the proxiaml femur?
and 2 main projections of superior shaft region
head and neck
Where does the head of promxial femeur articulate with?
acetabulum of pelvic bone,
what is the fovea?
non articular fit on medial surface for attachment of ligament of the head
what is the intra-capsular and extra capsular
and what denotes them?
what area does the retinacular vessel supply?
where does it supplied from?
fermonral head and beck,
from extra caplsular aterial ring supplied by lateral and medial circumflex vessels and
refinforced by superior and inferior gluteal arteries
what is a non-major artery to fermoral head? (post skeletal maturity)
metaphyseal vessels
What is inneravation of lateral circumflex fermonal artery?
lateral side of profunda fermoris
connects with branch of medial circumflex femonral artery form channel circulates neck of femur supplies femoral neck and head
what do the 3 ateries look like on a diagram?
What 2 classification of hip fractures?
Which type of fracture is the worst?
intra capular asscoaited high risk of distuption and interrupt in blood supply to femonral suuply
as close promoxity of retinacular vessels
What is garden calssifiction a predictable tool of?
avascular necoris i.e bone infaction
What is garden 1?
undisplaced, incomplete
valgus impacted (outward inanglulation)
what is garden 2?
undisplaced, COMPLETE
no disturbance of medial trabeuclae
what is garden 3
partially displaced
complete fracture
medial trabeculae out of line with pelvic trabeculae
what is garden 4?
How can you assess how much displacement of hip joint?
shenton’s line
What are osteogenic cells?
bone stem cells, precusor to other bone cells
What are osteocytes?
maintaining bone strucutre, former osteoblasts embedded in calcium hydroxyapatite secretions
What is mechanosta theory
Bone strucute is influenced by mechanical laoding,
how bones chnage with havitual mechanical demands
What does incrase habitual mechanical laoding force do?
higher strain stimulus being exerted on bone.
This puts the bone into a state of overload if it passes the formation threshold.
Formation modelling begins:
-osteocytes undergo perturbation (increased activity)
-Bone tissue is secreted by osteoblasts as osteocytes are continuing to maintain it. This results in an increase in bone density and therefore whole bone strength.
how are intracapsular fractures fixed?
garden 1/2 - cannulated hip screws
garden 3/4 - total hip replacement or hemi arhoplasty
when would you choose to give a hemi-arthoplsaty?
patients:
able to walk out of door with no more than stick
not coginively imparired
are medically fit for anaethsia for proceudre
what are the types of extracapsular fractures?
interchanteric
subchanteric
how can intertrochanteric fractures be manged?
dynamic hip screw or intra medullary nail
what is a good thing about dynamic hip screw?
more effective as it lets fracture ends slide, increase habital stress that promotes healing
How are subtrochandetric fractures manged?
intra medullary nail
how exactly does estradoil have affect on bone production?
stimaulates TGF actions on osteoclast/blasts
and inhbits IL-6, IL-1, TNF
what is denosumab drug action?
blocks RANLK lingand a powerful stimulant of osteoclast acitivty
treatment for osteoprosis intolerant of biphosophates
used for 2nd prevention for postmenopausal women with increased risk of fractures difficulty using alendronic acid
What is a main type of drug treatment for hip fractures and how does it work?
bisphosponates
binds to hydroxypatite crystals
decrease rate of bone resportion and increase bone mineral density
maintain strucutral and material properties of bone
what is alendronic acid?
what is a main benefit of it?
syntheric analogue of pyrophosphate - used for oestoperosis
inhibts enzyme for osteoclast turnover resportion
reduced bone resportion and osteocalsts
normally prescribed (main drug) and can be taken orally
What is tetriparadetide, when is it used?
PTH treatment, as increase osteoblast activity
usually taken with vitamin D
usually for postmenopausal women
usally 3rd line treatment, only used in sever osteporis
when biphosphonates not effective
What is zolendroic acid?
What is special about it?
only IV admisniton
slows down bone rsportions, allow more osteoblasts activity
How does raloxifene work?
When would you use it?
prevents osteoprosis in post-menoapusal women
mimics osteogresn
works by being a slective oestrogen receptor modulator
what happens in delirum
happens when someone is very ill
worsening of a person’s mental state - they are more conufsed than usual
what is stonritum renelate not used much?
only used severe osteoprosis
when other approved options not possible due to increase risk of heart attack
What is hyperactive delirum?
restless, agiated, agrresive, distressed, delusions,paranoid
hypoactive delirium?
withdraw, drowsy, unable sleep, can’t stay focussed when awake,
what is the other type of delirium?
mixed delirium - mixture of symptoms
Causes of delirmum?
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Electrolytes
How is it different to dementia?
similar symptoms
delilirum is very sudden 1-2 days and vary a lot
What treatment of delirium?
address underyling medical problem causing it e.g infection
stop medication
support + don’t move unnecciarly
provide supportive environemnt
