Trauma fractures

Major risk factors include current smoker, low body weight (<127 lb in postmenopausal women), history of osteoporotic fracture in a first-degree relative, and personal history of low-trauma fracture as an adult. Other independent risk factors include age, high bone turnover, low body mass index (<19 kg/m2), rheumatoid arthritis, and glucocorticoid use. Decision tools may help identify individuals who should undergo BMD testing, such as the Osteoporosis Risk Assessment Instrument and the Simple Calculated Osteoporosis Risk Estimation. 

The diagnosis of osteoporosis based on a low-trauma fracture or central hip and/or spine DXA using World Health Organization T-score thresholds. Normal bone mass is a T-score greater than -1, osteopenia is a T-score of-1 to -2.4, and osteoporosis is a T-score at or below -2.5. 

Table 2.7 Percentage increase in resting energy expenditure in trauma, fracture, sepsis, burns or fever...

Numerous diseases and drugs can decrease bone mass (see Table 88-1). Secondary causes are suspected when osteoporosis occurs in premenopausal women, men younger than age 70, those with no risk factors, multiple low trauma fractures (especially at a young age), a Z-score less than -2.0 (see section below on quantification of BMD), or bone loss despite adequate drug treatment and calcium supplementation." Patients suspected of having secondary causes should undergo careful evaluation that includes a comprehensive physical exam and laboratory assessment. Both the osteoporosis and contributing disorders should be treated. 

Soft Tissue Injuries. Some of the more common soft tissue injuries are sprains, strains, contusions, tendonitis, bursitis, and stress injuries, caused by damaged tendons, muscles, and ligaments. A sprain is a soft tissue injury to the ligaments. Certain sprains are often associated with small fractures. This type of injury is normally associated with a localized trauma event. The severity of the sprain depends on how much of the ligament is torn and to what extent the ligament is detached from the bone. The areas of the human body that are most vulnerable to sprains are ankles, knees, and wrists. 

In certain diseases, such as osteomalacia, syphilis, and osteomyeHtis, bones break spontaneously and without a trauma. The severity of the fracture usually depends on the force that caused the fracture. If a bone s breaking point was exceeded only slightly, then the bone may crack rather than break all the way through. If the force is extreme, such as in an automobile collision or a gunshot, the bone may shatter. An open or compound fracture is particularly serious because infection is possible in both the wound and the bone. A serious bone infection can result in amputation. 

In 1965 Zapffe found that after fracture trauma local pH values decreased to 5.3-5.6. As healing took place the pH increased gradually to the normal 7-4. Another source of low local pH in vivo is the presence of crevices between components of a fixation device. A restriction of the oxygen supply to these locations can lead to pH values of about unity . 

Paget s disease is a chronic bone disorder characterized by abnormal bone remodeling. The disease disrupts the growth of new bone tissue causing the bone to thicken and become soft. This weakens the bone, which increases susceptibility of fracture even with slight trauma or collapse of the bone (eg, the vertebrae). 

Vascular inujury Major orthopedic surgery (e.g., knee and hip replacement) Trauma (esp. fractures of the pelvis, hip, or leg) Indwelling venous catheters... 

Bone is one of the few tissues capable of self-regeneration during skeletal deficiency, but this regeneration is limited by the nature and size of the defect. In general, skeletal deficiency occurs as a result of trauma, tumor, bone disease, or abnormality. In the case of severe fracture, bone will not heal by itself. For this reason, artificial bone substitutes may be required to restore routine function without damaging living tissue, and the selection of the bone graft substitute is the most important factor for better performance in vivo. 

Major lower extremity orthopedic surgery Hip fracture Multiple trauma... 

A history of head trauma with or without skull fracture or presence of a chronically draining ear is associated with pneumococcal involvement. 

Pain Action Unknown but may stimulate opioid sites, sedation and analgesia Dose Adults. Self administered inhalation (generally 25-50% w/ oxygen) until pain relief or pt drops mask/falls asleep Peds. Same as adult (onset w/in 2-5 min) Caution [ , ] Do not use after full meal Contra EtOH intox AMS following head injury COPD, thoracic trauma Disp Supplied in blue cylinders SE N/V, Light-headedness, AMS and hallucinations Interactions T CNS depression Wf opiates, EtOH, sedatives EMS Do not strap mask to pt s face, allow pt to hold the mask to their face dosing is self-limiting when pt drops mask d/t CNS depression typically used for bums and fractures... 

Breaches in the integrity of the skin (eczema, trauma or burns) are predisposing factors for infection. Lymphoedema represents a risk for erysipelas. Open complicated fractures are often complicated by chronic osteomyelitis. Patients with diabetes mel-lims have more frequent as well as more severe infections of the skin, soft tissue and of bone. Sickle cell disease predisposes to osteomyelitis. 

Osteoporosis is a metabolic bone disease characterized by low bone mass and micro-architectural deterioration of bone tissue. This will lead to bone fragility and consequent increase in bone fracture risk. Mean bone mineral density (BMD) is measured with dual X-ray absorptiometry (DEXA) and expressed in Tsc (Tscore). WHO standards are a Tsc that is 1 standard deviation (SD) below mean BMD is graded as normal bone, Tsc between 1 and 1.5 SD below mean BMD is graded as osteopenia and a Tsc of more than 2.5 SD below mean BMD is graded as osteoporosis. When the Tsc is below 1.5 SD mean BMD prevention of osteoporosis must be initiated. Primary osteoporosis is caused mainly by hormone deflciency in both women and men. Secondary osteoporosis may result from endocrine, metabolic, nutritional and autoimmune causes or from immobility because of trauma. Also the use of medicaments such as corticosteroids may be contributing. 

Bone tissue has a rather unique capability among human tissues in response to injury or other changes that alter its mechanical requirements it can continuously remodel itself to meet those mechanical needs best [51, 52], For example, when a bone fractures, the body creates new bone to connect the broken fragments together, and then remodels the new bone to optimize its mechanical function in the particular region of the skeleton that the fracture has occurred. Human skeletal tissue has several functions, but, when a bone is fractured by trauma, or removed surgically due to disease or tumor formation, we only seek solutions so that its mechanical function can be carried out [53, 54],... 

Trauma or fracture may cause blood stagnation directly in the local area. 

Xu Duan can invigorate the blood and promote the healing process of the bones and tendons it is especially suitable to treat trauma and fracture. 

A seven-month-old child "fell over" while crawling, and now presents with a swollen leg. At age one month, the infant has multiple fractures in various states of healing (right clavicle, right humerus, right radius). At age seven months, the infant has a fracture of a bowed femur, secondary to minor trauma (see x-ray below). The bones are thin, have few trabecula, and thin cortices. A careful family history ruled out nonaccidental trauma (child abuse) as a cause of the bone fractures. The child is most likely to have a defect in ... 

Roy-Camille R, Mazel C, Husson JL, Saillant G. Symptomatic spinal epidural hpomatosis induced by a long-term steroid treatment. Review of the literature and report of two additional cases. Spine 1991 16(12) 1365-71. Andress HJ, Schurmann M, Heuck A, Schmand J, Lob G. A rare case of osteoporotic spine fracture associated with epidural lipomatosis causing paraplegia following longterm cortisone therapy. Arch Orthop Trauma Surg 2000 120(7-8) 484-6. 

For the relief of pain arising from spasm of smooth muscle, as in renal or biliary colic, morphine is frequently employed. Other measures including antispasmodics such as atropine, atropine substitutes, theophylline, nitrites, and heat may be employed first however, if they are ineffective, meperidine, methadone, or opiates must be used. Morphine relieves pain only by a central action and may aggravate the condition producing the pain by exaggerating the smooth muscle spasm. Morphine may also be indispensable for the relief of pain due to acute vascular occlusion, whether this be peripheral, pulmonary, or coronary in origin. In painful acute pericarditis, pleurisy, and spontaneous pneumothorax, morphine is likewise indicated. Carefully chosen and properly spaced doses of codeine or morphine may occasionally be necessary in pneumonia to control pain, dyspnea, and restlessness. Traumatic pain arising from fractures, bums, etc., frequently requires morphine. In shock, whether due to trauma, poisons, or other causes, morphine may be required to relieve severe pain. 

Osteoporosis is defined as a generalized decrease in bone mass (osteopenia) that equally affects bone matrix and mineral content and is associated with a change in spon-giosal architecture. This condition predisposes to collapse of vertebral bodies and bone fractures with trivial trauma (e.g., hip fractures). 

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