![]() ![]() Early treatment aims to minimise the length of time a patient is confined to bed rest, thereby reducing the risk for associated complications, such as pressure sores, deep vein thrombosis (DVT) and urinary tract infections (UTI). Since 2008, the Italian Ministry of Health has introduced the rate of proximal femoral fracture treated within 48 hours as one of the indexes of hospital efficiency 7. This is due to patient-related factors such as pre-existing chronic comorbidities and fracture-related factors like bleeding, anaemia and exposure to proinflammatory conditions that can worsen prognosis 5, 6. This condition is associated with increased morbidity and mortality, with estimated 1-year mortality rates between 14 and 36% 1-4. The incidence is expected to increase each year due to increasing life expectancy. In fact, more than 250,000 hip fractures are estimated annually in the United States in people over 65 years old. ![]() Proximal femoral fractures in elderly patients are a widely diffused entity in orthopaedic scenery. An algorithm could help standardise procedures and provide a tool for safe management of these patients. The surgeon should not rush to treat a suspicion of a pathological fracture without having performed all necessary investigations.Ĭonclusions. Orthopaedists must doubt a pathologic fracture. While bone metastases are the expression of a systemic disease, bone sarcomas have an extremely aggressive local course and an incorrect surgical procedure could heavily affect prognosis of the patient. Results. Proper imaging is essential in the management of bone metastases, along with appropriate laboratory tests and within a multi-disciplinary setting. Evidence from the literature was merged to define a flowchart for a safe clinical-diagnostic pathway. Methods. A review of the literature on diagnostic and therapeutic tools in pathologic fractures of the hip was conducted. This paper aims to investigate the current literature and to propose an algorithm to manage patients more securely. In such patients, a pathologic fracture of the proximal femur is not an uncommon event and may be consequent to bone metastases or primary tumours. There is a transverse pathologic fracture through the lesion.Objective. Current Italian guidelines recommend surgery within 24 hours from admission for hip fractures of the elderly. There is a permeative, lytic, and destructive lesion in the proximal femur with endosteal scalloping. There is a transverse pathologic fracture (white arrows) through the lesion. There is a permeative, lytic, and destructive lesion (black arrows) in the midshaft of the humerus with endosteal scalloping. Cement or bone graft may be used to fill a significant defect.While radiation may help pain, it may also delay osseous healing.If the bone is weight-bearing, such as the femur, intramedullary rodding is frequently used.Fatigue fractures occur with repetitive stress in normal underlying bone.Insufficiency fractures are seen with osteoporosis, not associated with a visible focal abnormality.On MRI, non-pathologic fracture-related hematoma.Soft tissue mass and infiltration of the muscle.Frequently associated with a soft tissue mass.Fracture line extending through a destructive lesion in the bone.Most common primary sites are breast, prostate and lung.Soft tissue swelling or mass which may pre-date fracture.May occur in osteoblastic as well as osteolytic metastases.Suspect when there is an avulsion fracture in an unusual location, spontaneous avulsion of lesser trochanter in adult.May also involve enchondroma, unicameral bone cysts.Most frequent through a metastatic lesion or multiple myeloma.By definition, a fracture that occurs through bone which was previously abnormal. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |