Chief Complaint 72yearold woman who fell on her right hip Hi

Chief Complaint: 72-year-old woman who fell on her right hip.

History: Margaret Donovan, a 72-year-old white female, was brought to the emergency room by her son-in-law after falling in her bathtub. She was previously in good health, despite leading a relatively sedentary lifestyle and having a 30-year history of cigarette smoking. The only medication she currently takes is Inderal (propranolol) for mild hypertension (high blood pressure). She fell upon entering the bathtub when her right leg slipped out from under her; she landed on her right hip. There was no trauma to her head, nor does she complain of right or left wrist pain. However, she reports severe pain in the right hip and upper thigh, and was unable to get up after her fall. An injection of oxymorphone hydrochloride (Numorphan) helped relieve her pain and she was taken to the radiology department for an X-ray of her right leg and hip.

Physical examination: The patient was alert, oriented to time, place and date, and was responding appropriately to questions despite being in considerable pain. There were no signs of trauma to the head, neck, torso, arms or left leg. The right thigh and hip were extremely tender and were immobilized by a leg splint. Heart and lung sounds were normal and abdominal sounds were reduced.

Radiology report: The X-ray of the right hip revealed a complete, comminuted, intertrochanteric fracture of the right hip. No other fractures were noted in the right leg. There were also long-term osteoporotic changes in the femur, tibia and fibula.

Surgeons performed an open reduction of Margaret’s fracture, immobilizing the bones with internal pins. ORIF is a procedure in which the broken bones are re-aligned and long, thick pins are inserted lengthwise into the bone tissue. The pins are held in place by screws drilled in from the outside of the bone.

Please Answer the Following Questions

Please answer the following questions regarding this case study.

1. Pick out at least 5 med term words from the case study and dissect them into their prefixes, suffixes and word roots – defining each.

1.

2.

3.

4.

5.

2. What is meant by a “complete, comminuted, intertrochanteric fracture of the right hip?”

Use as many medical term words as possible to answer this question:

Solution

1. Hypertension- Hyper tension refers to high or elevated tension or pressure of blood.

The blood flowing through the arteries pushes against the inside of artery walls. More the force exerted on the artery walls, the higher the blood pressure. When the muscular walls of arteries are relaxed, or dilated, the blood pressure is lower, when the artery walls are narrow, or constricted, the BP is more. The BP is highest when the heart beats (systolic pressure) to push blood out into the arteries. When the heart relaxes, the pressure is at its lowest point (diastolic pressure). Normally, the systolic pressure is stated first and the diastolic pressure second. Both are measured in millimeters of mercury (mm Hg). The normal blood pressure of an healthy adult is 120/80 mm Hg. Hypertension is the condition of repeatedly elevated blood pressure exceeding 140 / 90 mmHg.

2. Trauma- (trau·ma, traw´mah- Gr. means \'wound\') Trauma is a physical or emotional wound or injury.

In the present case, it refers to physical injury caused by violent or disruptive action due to sudden fall of the patient in the bath tub.

3. immobilized-immobilization

Immobilization refers to the process of holding a joint or bone in place with the help of a splint, cast, or brace; so as to prevent broken bones, dislocated joints, and injured soft tissues (tendons and ligaments) from moving until it heals. This method reduces pain, inflammation, and muscle spasms. The splints and casts applied after surgical procedures repair bones, tendons, or ligaments; and enable early healing process.

4. Osteoporosis

Osteoporosis means \"porous bones.\"

It is the condition where the bones lose excessive amount of the protein and mineral content, particularly calcium. Over time, bone mass, and bone strength, is decreased and the bones become fragile and break easily. The normal balance between the activity of bone-building osteoblasts and bone-resorbing osteoclasts is affected; activity of the latter being more, which result in loss of total bone volume. While everyone experiences slow, gradual loss in bone volume after age 30, those with osteoporosis have accelerated loss.

2. The type of fracture, where the parts of the bone are broken and completely separated from each other is referred as a complete fracture. There is also the complete separation of the cortex circumferentially. This type of fracture can be classified into:

As mentioned above, the comminuted fracture refers to the broken bone being shattered into smaller pieces. This includes a very heterogeneous group of fractures from a three part humeral head fracture to a multi-part fracture of the femur resulting from high impact vehicle accident.

Intertrochanteric fracture is one among the three types of hip fractures. This type of fracture occurs in femur or thigh bone, specifically at the upper part (proximal femur) consisting of femoral head, the femoral neck, and the trochanteric region (the greater and lesser trochanters). A trochanteric hip fracture occurs between the greater trochanter, and the lesser trochanter. At the greater trochanter the gluteus medius and the gluteus minimus (hip extensors and abductors) attaches, and at the lesser trochanter, the iliopsoas (hip flexor) attaches. The other two types of hip fractures are the fractures of the femoral neck, (proximal or cephalad to trochanteric fractures) and subtrochanteric fractures, (distal to or below the trochanters). Though commonly referred as hip fractures, the exact type is significant as the anatomy, prognosis, and management are different.