musculoskeletal emergency presentations

Question 1

78 yr old lady tripped and fell, can’t get up. Pain in right groin. Had a fall one yr ago and sustained wrist fracture. She had a right hip fracture which required fixation. What is the differential diagnosis for her pain?

Answer 1

• High risk of hip fracture. Yet, is important to rule out other causes of her right groin pain.
• Was it painful prior to her fall (think osteoarthritis)
• Can you see a lump (think hernia)
• Can you feel for lumps (think lymph nodes)
• Any change in sensation (think nerve impingement)
• Deformity of the lower limb e.g. short and externally rotated (think hip fracture)

Question 2

what are risk factors for osteoporosis?

Answer 2

Lifestyle

• Excess alcohol
• Smoking
• Physical inacitivity
• Low body weight

Drugs

• Glucocorticoids
• Antiepileptic
• Anticoagulant (heparin)

Endocrine

• Hypogonadism
• Hyperthyroidism
• Cushing’s disease
• Growth hormone deficiency
• Hyperparathyroidism

Medical disorders

• Malnutrition/malabsorption
• Anorexia nervosa
• Inflammatory intestinal disease or intestinal resection
• Chronic inflammatory disease (rheumatoid arthritis)
• Transplant patients (solid organs and bone marrow)
• Systemic mastocytosis (too many mast cells)

Question 3

what is the difference between osteoporosis and osteomalacia?

Answer 3

Osteoporosis

• Weakening of bones- more likely to fracture- caused by reduced bone density

Osteomalacia

• Inadequate mineralisation of bone causing soft bones
• caused by vit D deficiency so insufficient Ca2+ absorption or insufficient dietary intake, chronic kidney failure, bone-tumour induced, coeliac disease