Skeletal System Cases

1. Skeletal System Cases See if you can solve the case.

2. Case #1: Phyliss C. Phyllis C. is a 45-year-old female who weighs 250 pounds. One evening she decided to take her two sons roller-skating. Phyllis had not been skating for at least ten years but she felt confident that it would be easy to relearn to skate. After the second turn around the rink she was pushed from behind and found herself falling into a large group of skaters. She could not get up and walk so she had to be transported to the emergency room.

3. The emergency room physician ordered an x-ray of her leg. The results indicated a transverse fracture of the tibia. A fiberglass cast was placed on her leg and she was sent home. She was given instructions to inspect the skin around the edges of the cast for redness, irritation and extreme swelling.

4. Twenty-four hours after Phyllis went home, she began experiencing extreme pain in her leg. Acetaminophen with codeine did not help and elevating the leg increased the pain. She called her physician and was told to come immediately to the office.

5. Questions 1. Why did swelling occur so rapidly after the fiberglass cast was placed? 2. What effect did the body’s release of histamine due to the inflammatory process have on compartment pressure? 3. If Phyllis had not sought immediate treatment what would have been the end result of rising pressure in the compartment? 4. Will Phyllis be more likely to experience another fracture in the same area? Why or why not? 5. What did the fracture look like to the physician examining the x-rays?

6. Case #2: Mary K. Mary K., is a 70-year-old widow who resides in a nursing home. She is 5'1 and weighs 150 lbs. Her thyroid gland was removed when she was 60 but otherwise her health has been good. She uses a walker when she feels able but usually can be found in a wheelchair. Her shoulders appear rounded and her spine curved. When Mary was younger, she enjoyed walking and playing golf. Her diet consisted mainly of red meats and carbohydrates. She did not like the tastes of milk products except for cheese.

7. Four months ago Mary slipped and fell on a patch of ice while visiting her granddaughter. She was in severe pain, could not move the left leg voluntarily and it was shorter than her right leg. Her vital signs were normal and circulation was excellent. X rays were ordered. Diagnose the injury.

9. Mary was hospitalized for one week with a fracture of the hip. Surgery to repair the fracture was completed and she was placed on non-weight bearing status for 6 weeks to 3 months. Physical therapy was performed for 3 months so that Mary would understand the limits of motion required after surgery and how to increase her activities gradually.

10. Hip fractures are a serious problem for elderly persons. As the incidence of osteoporosis increases, the incidence of fracture of the femoral neck of the hip increases by 40%. An intracapsular fracture occurs within the hip joint and capsule. Surgery to correct the fracture involves reduction and stabilization of the fracture and insertion of an internal fixation device.

12. Questions: 1. What effect did Mary's diet have on her appearance? 2. How does removal of the thyroid gland affect osteoblast activity? 3. Why is Mary using the wheelchair instead of the walker? How long does it normally take bone to repair? 4. Why did Mary most likely fracture her hip? 5. Why would the blood supply to the head of the femur be affected by this type of fracture?