Clinical trial on patient osteoporosis
Osteoporosis is a skeletal disease in which there is a decrease in bone mass density. Thus, the bones become more porous, increasing the number and size of the or cells that exist inside, which causes the bone to become more fragile and before any blow it breaks easily.
Causes
Anyone can develop osteoporosis, but it is more common in older adult women. Risk factors include:
- The aging
- Be of small and thin size
- Family history of osteoporosis
- Take certain medications
- Be a white or Asian woman
- Have low bone density
Symptoms
This disease is very silent so the patient realizes when there are fractures and a bone mass density exam is performed
The most common fractures in osteoporosis are those of the proximal femur, humero, vertebrae and distal forearm (wrist).
Prevention
The diet that the person carries is of vital importance. A balanced diet, adequate in calories and nutrients, is essential for the development of all tissues, including bone. In addition, calcium is the most important specific nutrient to achieve an adequate bone mass peak.
Anamnesis
78 -year -old woman who goes to consult. He says that the pain begins after suffering an accidental fall and that does not yield with analgesic treatment.
Among its personal history, arterial hypertension, atrial fibrillation in acenocumarol treatment, right parietal venous angioma, cerebral cerebral infarction, left frontal cerebral infarction and total frontoparietal subaguar.
Physical exam
To the exploration, a very claudicating march is observed with two canes. An important thinness is evidence.
The patient refers to pain to the palpation of the spinous process of the low and lumbar dorsal column (D11-L3) with negative lasègue and bragard signs. The mobility of the lumbar column is painful, as is the left hip, and there is an important functional limitation (90º flexion, abduction 45º, internal rotation 20º and external rotation 40º).
Supplementary tests
- Anteroposterior and lateral RX: fractures of D11, L1, L2 and L3, and ascent of the total prosthesis cotyl, which is located in the pelvic region.
- RM: Acute fracture of L1, L2 and L3 with sinking of the upper dishes with minimal scale of the rear wall of the vertebra L3 towards the spinal channel with stenosis. In the study of the dorsal column, ancient fractures of D6 and D11 are observed (fig. 1).
- Gammographic bone study of the lumbar column, of the pelvis and both hips: hypercapteric bone lesions in the left coxofemoral region with hyperemia and heterogeneous hyperosteogeny, mainly around the cotilo, suggestive mobilization of the same. Bone lesion spotlights are displayed in the dorsolumbar column with intense hyperosteogeny in the D6, L1, L2 and L3 vertebral bodies in relation to vertebral crushes of osteoporotic origin.
Diagnosis
Multiple vertebral fractures along with mobilization of the total prosthesis cotilo of the left hip.
Treatment
After the valuation of the diagnostic tests and the patient’s clinic, it is decided to perform surgical treatment in two times.
In the first place, a ciphoplasty with L1, L2 and L3 is practiced. A histological study of the extracted material is carried out, which reports the presence of plasmocytosis. No alterations in the hemogram or biochemistry are found. As for the light -free light chains in serum, a Kappa/Lambda ratio of 0.84 is obtained. Serum and urinary proteinograms are normal. The study is completed with bone marrow aspirate and flow cytometry, which do not reveal alterations.
Having ruled out the possibility of being faced with a myeloma, it is decided to intervene to solve the mobilization of the prosthetic component. A subsequent approach is performed in which an osteotomy of the rear third of the trochanter is practiced creating a flap formed by the major trochanter, the posterior capsule, the short external rotators and the back of the medium gluteus, which is subsequently reflected and allows to extract thecotilo and replace it with a tontal cotilo with screws and polyethylene, without observing mobilization of the stem (fig. two). After checking the stability of the new prosthetic component, the old -clutching trochanter is anchored with two cracks and the muscles are reinsert.
Evolution
The RX shows good adaptation and guidance of the tantalium cotilo.
During the postoperative period, the patient suffers a stroke, but leaves no sequelae and does not prevent her from leading a normal life.
Bibliography
- osteoporosis. (s.F.). Spanish Rheumatology Foundation. Retrieved on May 10, 2019, from the Spanish Rheumatology Foundation: https: // inforeuma.com/disease-reumatic/osteoporosis/
- United, b. n. (April 29, 2019). Medlineplus. Retrieved on May 10, 2019, from Medlineplus: https: // medlineplus.GOV/Spanish/Osteoporosis.HTML
- Cuidateplus. (August 28, 2015). Retrieved on May 10, 2019, from CuidatePlusv: https: // Cuidateplus.brand.com/diseases/muscles-and-huesos/osteoporosis.HTML
- Lozano, j. A. (June 2003). Osteoporosis. Elsevier, 22 (6), 9-170.
- María Brotat Rodríguez García Medrano, C. V. (2010). Clinic history. Retrieved on May 10, 2019, from the Spanish Society of Orthopedic Surgery and Traumatology: https: // www.SECOT.is/Viewer/Case.PHP?id = 402 & annual = 2012
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