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Abstract: Compression fracture, or compression fracture, is a common type of fragility fracture in the elderly population. In this case, the patient was diagnosed with a compression fracture of the thoracic 12 vertebrae after an examination for thoracic and lumbar pain and limitation of movement after a fall, which prevented normal weight-bearing walking. The patient was treated with percutaneous vertebroplasty, after which the pain in the thoracic back gradually disappeared and the patient resumed her daily living ability.
Basic information】Female, 75 years old
Disease Type】Compression fracture
Hospital】Liaocheng Second People’s Hospital
Consultation time】November 2021
Treatment plan】Surgical treatment (percutaneous vertebroplasty)
Treatment Period】Inpatient treatment for 3 days, outpatient review after 1 month
Effectiveness】The pain in the thoracic back disappeared and the patient regained the ability to perform daily activities
I. Initial consultation
An elderly female patient was pushed into the orthopedic clinic by her family in a wheelchair, with a painful face. The patient felt pain in the thoracic back and did not dare to move around, and the pain increased when he coughed. On visual examination, the patient was found to be bent forward, and a gentle tap on the thoracic back caused severe pain.
II. Treatment history
The X-ray findings were explained to the patient and his family and they were informed of the treatment options available to them: conservative treatment or surgical treatment. If conservative treatment was chosen, the patient would be strictly bedridden for 1 month, during which time he would not be able to sit up or move to the floor, including eating and urinating and defecating, and daily activities would need to be performed in a bedridden state, and prolonged bed rest could cause complications such as pressure sores, lung infections, and urinary tract infections. Percutaneous vertebroplasty, a minimally invasive treatment method, can be performed through local anesthesia by placing a puncture needle and injecting medical bone cement into the compressed vertebral body through the needle, allowing the patient to get out of bed for early weight-bearing activities, but there is a risk of cement leakage. The family members considered that the patient could take care of himself before the injury, and finally chose surgery in order to restore the patient’s ability to live as soon as possible. After admission, the MRI of the thoracolumbar spine was further improved, and thoracic 12 percutaneous vertebroplasty was performed under local anesthesia on the second day. On the second day after surgery, the patient wore a thoracolumbar brace and walked on the ground, and was discharged after 3 days of hospitalization.
III. Treatment effect
The patient felt relief of thoracic back pain immediately after the operation, and the radiograph on the second day after the operation showed good cement filling and no obvious leakage, and the patient was instructed to wear a thoracolumbar support and walk on the ground. When the patient came to the hospital for follow-up one month after discharge, the patient could independently perform simple daily activities such as eating, toileting and washing. At the follow-up visit 3 months after discharge, the patient’s chest and back pain disappeared and basically returned to the ability of daily life before the injury, and was very satisfied with the treatment effect.
IV. Notes
We are glad that the patient was discharged from the hospital after treatment, but after discharge, he needs to continue to wear a thoracolumbar support for 1 month, using it to increase the strength of the low back muscles, promote the repair of soft tissue damage around the fracture, and prevent chronic low back pain caused by incomplete recovery of low back muscle function. Patients should also take oral anti-osteoporosis medication to improve bone density, as well as moderate daily activities and sunlight exposure to reduce calcium loss. Increase the intake of foods containing calcium and vitamin D, such as meat, eggs, milk, fish and shrimp. In addition, the patient needs to be attended to in the early stage after discharge to prevent further falls, and to come to the hospital for follow-up at 1 month or 3 months after discharge to assess the recovery of thoracic and back function, and to guide the anti-osteoporosis medication and proper functional exercise.
V. Personal insight
Compression fracture is a common type of fragility fracture caused by osteoporosis in the elderly population. In this case, the precipitating factor of the patient was a fall, so it is crucial to take fall prevention measures in daily life, such as adding handrails at home, wearing the right type of shoes, and improving the vision level of the elderly. Once a compression fracture occurs, if the patient’s condition allows, minimally invasive surgery is recommended to provide early relief of pain symptoms, restore the patient’s ability to perform daily activities, and prevent complications associated with long-term bed rest.