Today Wuhan ushered in the first snowfall of this winter, everywhere is the scene of snow drifting. Although it is a beautiful scene, but the road is slippery, accidentally will fall on a fall, for osteoporosis of middle-aged and elderly friends, perhaps a gentle fall will lead to serious fractures. It is said that a hundred days to hurt the bones, looking at the New Year, do you want to pose with crutches, wearing a cast for the New Year? Besides, in elderly people with osteoporosis, prolonged bed rest will not only aggravate the progress of osteoporosis, but also may occur complications such as lung infection and pressure sores. Adding to the patient’s pain can also increase the burden of care for family members. Below I will introduce some surgical management of osteoporotic fractures: Tian Hongtao, Department of Orthopedics, Wuhan Union Hospital
Common fracture sites in osteoporotic patients.
Spine
Clinical manifestations: mainly low back pain with or without numbness of both lower limbs, paraplegia with urinary and fecal incontinence in severe cases
CT-guided vertebroplasty treatment: refers to the percutaneous puncture implantation of a tube to inject medical bone cement into the vertebral body, which can provide early pain relief and support and strengthen the fractured vertebral body. It is suitable for low back pain caused by vertebral compression fractures in the elderly, and is suitable for elderly patients with many complications (such as cardiovascular disease, lung infection, etc.), those who should not be bedridden for a long time, those who have severe pain that cannot be tolerated, and those who have failed to achieve results after repeated conservative treatment. Its curative effect is remarkable, safe and reliable. It can restore the mobility of the elderly as soon as possible, and generally the next day after surgery can walk on the ground.
Features of vertebroplasty: ① Percutaneous puncture is a minimally invasive surgery with little trauma, and the puncture needle can be inserted into the vertebral body; ② High safety, no nerve and blood vessel damage generally occurs during treatment, and no other serious complications occur; ③ Definite efficacy, the patient’s symptoms of low back pain are obviously reduced or disappeared immediately or within a few days after surgery, and the efficacy can be maintained for a long time.
Hip
The most common are femoral neck fracture & intertrochanteric fracture.
Clinical manifestations: After a fall and injury in middle-aged and elderly people, hip pain, restricted movement of lower limbs, inability to stand or walk, or still able to walk after the injury, but the pain worsens after a few days and gradually unable to walk. The affected limb is shortened and its activities are restricted.
Total hip arthroplasty.
Replacement of the hip socket with a plastic joint socket; replacement of the broken femoral head with a metal joint head; insertion of a metal rod into the femoral stem to add increase the stability of the artificial joint.
Wrist
Colles fracture: also known as extension type distal radius (ráo) fracture, mostly injured when the wrist is in dorsal extension position, palm on the ground and forearm rotated forward, accounting for 90.2% of distal radius fractures.
After the injury, the fracture is characterized by local pain and swelling, and the wrist joint movement may be impaired, and the typical deformity may appear: a “silver fork” deformity in the lateral view, and a “spear-like” deformity in the frontal view. Sometimes it may be accompanied by lower ulnar radius dislocation and ulnar styloid fracture.
Smith fracture: also known as flexion-type distal radius fracture or anti-Colles fracture, often caused by a fall when the wrist is flexed and the back of the hand is injured, accounting for 7.8% of distal radius fractures, which is less common. The fracture is often caused by the dorsal aspect of the wrist, which accounts for 7.8% of distal radius fractures. Sometimes it can be combined with lower ulnar radial joint injury, ulnar styloid fracture and triangular fibrocartilage injury. It is the opposite direction of the extension fracture. There is also Barton fracture: also known as distal radius articular surface fracture with wrist fracture.
Surgical treatment: for comminuted intra-articular displaced fractures, open fractures, concomitant carpal fractures, combined vascular nerve injuries, and failure of non-surgical treatment.
Treatment of osteoporosis.
Prevention and general treatment: see “osteoporosis” (reply to “osteoporosis”)
Drug treatment
Calcium and vitamin D supplementation: Daily calcium intake should be 800-1200 mg, which can be supplemented with dietary supplements or calcium carbonate and calcium gluconate preparations.
Symptomatic management: Non-steroidal anti-inflammatory drugs, such as aspirin and celecoxib, can be used appropriately for pain.
Anti-bone resorption drugs.
① Bisphosphonates: effectively inhibit osteoclast activity and reduce bone conversion. For example, alendronate (Fosamax or Gupta) can significantly improve the bone density of the lumbar spine and hip, and significantly reduce the risk of fracture in the vertebrae and hip. ② Calcitonin: It is an inhibitor of bone resorption, which can prevent bone loss and increase bone mass. The main ones are salmon calcitonin (mikegaixin) and eel calcitonin analogs. Another outstanding feature of calcitonin analogs is that they can significantly relieve bone pain, and are effective for chronic pain caused by osteoporotic fractures or bone deformation, as well as bone pain caused by bone tumors and other diseases, and thus are more suitable for osteoporosis patients with painful symptoms ③ Selective estrogen receptor modulators (SERMs): they effectively inhibit osteoclast activity, such as raloxifene, which can stop bone loss, increase bone density, and Significantly reduces the incidence of vertebral fractures, and is an effective drug for the prevention and treatment of postmenopausal osteoporosis. This drug is only used for female patients. Estrogens: These drugs can only be used in female patients. Estrogenic drugs can inhibit bone conversion to stop bone loss.
(2) Drugs promoting bone formation: parathyroid hormone (PTH), which has the effect of promoting bone formation, can effectively treat severe postmenopausal osteoporosis, increase bone density and reduce the risk of vertebral and non-vertebral fractures, and is therefore suitable for patients with severe osteoporosis. It must be applied under the guidance of a medical professional. The duration of treatment should not exceed 2 years.
(3) Other drugs.
(1) Active vitamin D: appropriate doses of active vitamin D can promote bone formation and mineralization, and inhibit bone resorption. It includes osteotriol (Geisan Chun) and alfa osteotriol, which should be used under the guidance of a physician and regular monitoring of blood and urine calcium levels.
②Chinese herbal medicine: proprietary Chinese medicines such as strong bone capsules also have some clinical efficacy.
(The relationship between bone and calcium is not clear? For more details, see “Confused – osteoporosis or osteopenia?” for further answers)
(Image from the Internet)