Skeletal System Case Study Overview: Mrs. Donovan, a 72-year-old woman, is admitted to the hospital complaining of an extremely sore hip after a recent fall. Chief Complaint: right hip Notes: Mrs. 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 hypertention (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. She measures at 5'3" and weighs 102 pounds. Her temperature is 98.6, pulse is 84, and blood pressure 130/80. Her respiratory rate is 18. Mrs. Donovan's pain description indicates that the pain appears to originate in her sacral and lumbar regions and migrate upward toward the cervical region and throughout her pelvis. A black and blue contusion is visible on her upper right hip. Patient History: Last physical was eleven months ago. Her height was 5'4" and weight 108 pounds. Heart rate was 65 bpm and blood pressure was 120/90. Temperature was 98.2 and resting rate was 15 breaths/min. Radiology report: The X-ray of the right hip revealed a complete, comminuted, intertrochanteric (top part of the femur) 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. An open reduction surgery is recommended to immobilize the bones with internal pins. Questions 1. What is meant by a "complete, comminuted, intertrochanteric fracture of the right hip?" 2. Draw a picture of what you think Mrs. Donovan's fractured femur looks like. 3. The radiologist reports signs of osteoporosis. How is osteoporotic bone different from regular bone? 4. Why do bones become osteoporotic in some people? (What specifically is happening in the bones themselves?) Surgeons performed an open reduction of Mrs. Donovan's fracture, immobilizing the bones with internal pins. "Open reduction surgery" is a procedure in which the broken bones are re-aligned and long, thick pins are inserted lengthwise into the bone tissue. These pins are held in place by screws drilled in from the outside of the bone. 5. Describe the changes that a broken bone undergoes as it is healing. During her long recovery, Mrs. Donovan is advised by her physician to begin weight-bearing as soon as she can. To aid her in this regard, she begins light physical therapy three times per week. 6. How does weight-bearing influence the bone healing process? 7. In addition to the physical therapy benefits, why else might her physician want her to avoid prolonged bed-ridden activity? 8. What risk factors does Mrs. Donovan have for osteoporosis? 9. What bones are most vulnerable to osteoporosis and why? Following her recovery, Mrs. Donovan was placed on three medications: oral calcium supplements, oral estrogen, and oral alendronate sodium (Fosamax). (Fosamax is a drug which inhibits the activity of osteoclasts.) 10. Specifically describe how each of these medications works to treat Mrs. Donovan's condition.