osteoporotic fracture- presentation
DESCRIPTION
Osteoporotic Fracture- presentation. Sudden onset pain in thoracic or lumbar spine Minor trauma Sometimes there is no trauma A T10 fracture can cause pain in the lower lumbar spine- so palpate the whole spine - PowerPoint PPT PresentationTRANSCRIPT
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Osteoporotic Fracture- presentation
• Sudden onset pain in thoracic or lumbar spine• Minor trauma• Sometimes there is no trauma• A T10 fracture can cause pain in the lower
lumbar spine- so palpate the whole spine• A wedge fracture on xray may be tumour or an
osteoporotic fracture- so an MRI scan is essential
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Management• Blood tests: ESR, CRP, Bone
Chemistry, Serum Electrophoresis, Renal and Thyroid function, Vitamin D levels.
• Rule out secondary causes and tumours
• MRI scan and Xray• Consider a Bone Density Scan• Advise rest and pain killers• If pain not settling in 6 weeks
refer to spinal unit
COMMON SECONDARY CAUSES OF OSTEOPOROSIS• Renal problems• Diabetes• Thyroid dysfunction• Early menopause• Steroid usage• Drugs for Epilepsy• Parathyroid dysfunction
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Epidemiology
300,000 hip fractures/yr USA.700,000 spinal fractures/yr.1/3 new, 2/3 old.14 bed days/fracture.20% collapse can progress to 70%
collapse.Sex: 75% women .At 80 same incidence as men.
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Problems after Vertebral fractures• Transient Ileus• Urinary retention• Pain• Problems with
immobilization
• Kyphosis• Muscle deconditioning• Insomnia• Depression• Protuberant abdomen• Decreased pulmonary
function• Increased mortality0.5% risk of paraplegia
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23% increased mortality in women > 65years with Vertebral Compression Fractures compared with age matched controls.
KADO et al. Arch Intern med. 1999
9% reduction in Forced vital capacity per thoracic compression fracture
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Vertebroplasty- Bone Cement injection into vertebral body
• Originated in France – 1986• 70-90% pain relief• 1-6% risk of complications
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How does Vertebroplasty work?
• Reduced micro-motion and restoration of load transmission
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NEEDLES PLACED IN VERTEBRAL BODY UNDER XRAY CONTROL
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NEEDLES PLACED IN THE VERTERAL BODY UNDER XRAY CONTROL
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BONE CEMENT BEING INJECTED INTO VERTEBRAL BODY
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XRAY MONITORING OF CEMENT PLACEMENT THROUGHOUT
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AP XRAY OF CEMENT IN THE VERTEBRAL BODY
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F= 67. 6 year H/o back pain- 90% better after the procedure
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Results
• Significant pain relief is seen in 75-90% of osteoporotic fractures
• And in 59-86% of malignant fractures.• Increased mobility• Reduced analgesic requirement• Results are sustained over time• Complication rates are low and include
cement leakage