Week 8 Flashcards
The three scenarios to think about for fracture: Major trauma, compromised bone density/minor or no trauma, repetitive/unusual activity
Which does osteoporosis stress fracture go under?
Compromised bone density/minor or no trauma ; pathological fracture; bony tumor or osteoporosis can cause this
Definition of osteoporosis
Chronic progressive disease from low bone mass and strength, impaired bone quality; leading to higher fracture risk
Primary vs Secondary osteoporosis
Primary: associated with age-related changes
Secondary: bone density loss due to factors such as medications and illnesses; accelerate bone density loss
Common facts with osteoporosis
-most common metabolic disease
-most common in women, especially post-menopausal women
-men >70 high risk
Define: -osteomalacia
-osteopenia
-osteopetrosis
-osteoporosis
-osteomalacia: bone softening
-osteopenia: low bone mass
-osteopetrosis: increased bone density
-osteoporosis: systemic disease marked by decreased bone density
What are general risk factors associated with bone density compromise?
-Age 50 years and older
-Caucasian/Asian Race
-Northern European ancestry
-Female sex, especially women post menopause, or women who
have amenorrhea)
-Low body weight (thin, tall body frame)
-Long durations of Immobilization and inactivity
-Dietary deficiencies (Ca and Vitamin D)
Common medications that can lead to compromised bone density loss?
-corticosteroids
-anti-coagulants
-laxatives
-methotrexate
-benzodiazepines (Valium, Xanax)
*alcohol intake >2 drinks per day
*caffeine >3 cups coffee per day
4 most common osteoporosis fracture sites in order of most to least
-vertebral bodies (mid/low thoracic and lumbar spine)
-proximal femur
-ribs
-distal radius
Age for each gender at increased risk for osteoporosis vertebral compression fracture
-women: >65
-men >75
-Age>80
Findings from physical exam that would warrant a osteoporosis vertebral compression fracture
-post-trauma palpatory pain over midline in spinous process
-post trauma abrasion/contusion at painful site
-spinal deformity
-most intense pain during trunk flexion
Related to osteoporosis vertebral compression fracture: what are the alleviating & aggravating factors
alleviating:
-non-weight bearing postures
-relative relief with trunk extension posture/position
-if acute, avoid movement
Aggravated factors:
-trunk flexion activities especially in weight bearing position
-if acute, sharp pain with trunk movement
Anterior, middle, or posterior vertebral column: where do most osteoporosis vertebral compression fractures occur?
Anterior; trunk flexion motion compresses anterior and gaps posterior vertebral body
What view on radiology film gives the best view to see the vertebral body?
Anterior, oblique, or lateral
Lateral view
Pain location for osteoporosis related proximal femoral fracture
Deep buttock area, over greater trochanter and/or groin
-may have pain refer down anterior and medial thigh
Common physical exam findings associated with proximal femoral fracture
-antalgic gait
-with deep palpation, pain over femoral triangle and/or buttock region
-position of comfort for LE hip abduction and ER
-positive patellar pubic percussion test
*alleviating: non weight bearing
*Aggravating: weight bearing
Osteoporosis related rib fracture:
-aggravating factors, common onset of pain
Aggravating: taking deep breath, sneezing, coughing, reaching overhead lifting objects of any weight
Onset: sneezing, coughing, lifting
Osteoporosis related rib fracture:
What are some common examples of findings?
-pain with taking deep breath
-pain with palpation over area
-pain provocation with tuning fork placed over area of pain
-pain provocation with bowing test
Osteoporosis related distal radius fracture:
Common onset of injury, aggravating factors?
Onset: FOOSH
-caught yourself to prevent a fall; reaching for support with your hand
Which of the following would be the best test to screen for a
femoral neck fracture?
a. Using bony auscultation with percussion
b. Using a tuning for pain provocation
c. Using the bowing test
d. Using ultrasound for pain provocation
A; best for deeper structures
Stress reaction injury/fracture:
-basic knowledge
-progression of cumulative micro trauma that results in local inflammation that may progress to a frank fracture if the responsible activity isn’t modified
Fatigue vs insufficiency fracture
Fatigue: normal bone unable to withstand repetitive, cumulative loads
Insufficiency: normal load on bone that is compromised, weakened biomechanically
Brief description of each grade for a stress reaction injury
1: mild-moderate periosteal edema only on T2 weighted image
2: moderate to severe periosteal and marrow edema only on T2 weighted image
3: moderate to severe periosteal and marrow edema only T1 & T2 image
-4: moderate to severe periosteal and marrow edema only T1 & T2; plus obvious fracture line
Which scenario is at a greater risk for fracture progression:
-bone exposed to shear or tensile forces
-bone exposed to compressive forces
Bone exposed to shear or tensile loads
