Fractures in the Elderly

Question 1

physical exam finding of broken hip

Answer 1

shortened leg, externally or internally rotated depending on dislocation.

Question 2

75 year old female presents to the emergency department

• “caught her toe on the rug and fell”
• has right hip pain

interpret this XRAY

Answer 2

obturator foramen is asymmetric–she’s rotated in the bed

• head of femur looks like it has moved in front of the anatomical neck. rotated large trochanter.

Question 3

what is a fragility fracture

Answer 3

a fracture that occurs spontaneously or after minor trauma, such as a fall from standing height or less or walking speed or less.

Question 4

which gender is more susceptible to fragility fracture

Answer 4

women–50%

men- 22%

falls ae the cuase of 95% of all hip-fracturs

Question 5

note: statistics about hip fractures

Question 6

subcaptial hip fracture surgical treatment

Answer 6

• when the head of femur fracture or break– can affect blood supply to femoral head.

needs complete joint rotation replacement/hemoarthroplasty

Question 7

type of hip fracture?

Answer 7

subtrochanteric

Question 8

type of fracture>

Answer 8

intertrochanteric fracture

Question 9

the paradox in hip fracture treatment

Answer 9

• it considered a low risk/priority amongst emergencies and often results in being treated by a junior member of the team and a 2-4 day surgery average.
• BUT if it’s not treated by 24 hours, the recovery rate is VERY poor and often results in 1/3of the lederly peopel dying within the next year.

Question 10

comorbidities that can affect a fracture healing/surgical success

Answer 10

Question 11

what kind of fracture?

Answer 11

subcapital– there is an increased chance that blood supply to femoral head is compromised.

Question 12

osteoporosis

Answer 12

disease characterized by low bone mass and deterioration of bone leading to bone fragility and risk of fractures, particularly of the hip spine wrist and shoulder.

Question 13

osteoporosis is defined as bone density of ____ SD below that of a young adult

Answer 13

2.5 standard deviations below.

Question 14

how is osteoporosis bone density measured?

Answer 14

by dua;-energy X ray absorptiometry (DXA)

Question 15

recommended calcium and vitamin D intake

Answer 15

Total calcium intake of 1200 mg/ day (includes
diet) & vitamin D 1000 IU/ day + fall prevention

Question 16

risk factors of osteoporosis in men and women over 50

Answer 16

Determine if have low BMD or risk factors
— Long term steroid use; fragility fracture (40+); vertebral
fracture or osteopenia on x-ray; certain diseases
(rheumatoid arthritis, malabsorption states, primary
hyperparathyroidism, hypogonadism)

Question 17

OST equation for likelihood of developing OA

Answer 17

OST = weight (kg) - Age (years)

—OST 10+: low risk of osteoporosis; reassess OST
in five years

—OST < 10: moderate-high risk of osteoporosis;
obtain DXA BMD to determine absolute
fracture risk over the next 10 years

Question 18

general pharmacotherapy for osteoporosis

Answer 18

1. antiresorptive agents
2. promotion of bone formation

Question 19

the TUG test (timed get up and go test) can help assess:

Answer 19

gait and liklihood of falling. the time to sit, stnad up walk 3 meters and sit down again should take less than 12 seconds.

Question 20

note: fall prevention in elderly

Question 21

femoral head fractures cause___ rotation on presntation and femoral neck fractures cause __ rotation.

Answer 21

femoral head fractures MEDIAL rotation on presntation and femoral neck fractures cause LATERAL rotation.