Atypical Geriatric Bone Fractures (Nursing)

00:00 So last one, before we go on to that I want to talk about an atypical example.

00:08 So wait a minute, we're talking about all these fractures.

00:11 Let's go back and give you a scaffolding.

00:14 Why are elderly people experiencing fractures? Good. I hope you said because they've developed osteoporosis, which means a porous bone.

00:24 Porous bones are weaker bones.

00:26 So they're more likely to develop a fracture.

00:29 When we talk about the two most common areas to see that vertebral compression fractures and hip fractures.

00:37 Now I'm going to talk about something atypical.

00:40 This is an atypical thing, which means it doesn't happen very often, but it's a femur fracture.

00:47 So look at our bone, you'll see that it goes all the way across, right, that's considered a transverse fracture.

00:55 Now, this is rare, but it's possible.

00:58 You have like a break or a crack in the middle of your femur.

01:02 Now, you may call that your thigh bone, but that's one of your long bones.

01:07 This can be a real problem, right? When you have a fracture in that bone.

01:11 Now that's going to have to be repaired.

01:13 So who's at risk for this, if it's atypical? Who's most at risk for this? Well, people who are on long term biphosphonate therapy.

01:22 So someone who's had osteoporosis, and they receive a type of medication called a biphosphonate.

01:29 They take it over a long period of time.

01:31 Sometimes this can change their bones at a really microscopic level.

01:35 So they happen to be just a little more susceptible to this rare type of fracture.

01:40 Now this one is a big deal.

01:43 Sometimes you even called catastrophic transverse breaks.

01:47 Those are called atypical femoral fractures.

01:50 Whoo. That's a lot of names.

01:53 What are the key takeaway points you need to know when you're caring for patients? Well, when you recognize that a patient is on a biphosphonate, you want to make sure that you're on the lookout for this.

02:05 They know that there are some increased risks with this medication.

02:10 If a patient tells you, they're having severe leg pain, and you know they're on biphosphonates, this is what you're going to start thinking right away.

02:18 So those of you that want to be an ER, and you start seeing these signs where an elderly client comes in, you know that they're on biphosphonates.

02:25 And they're telling you they're having severe leg pain, you can bet, you in the healthcare provider gonna be looking at an x-ray, very soon.

02:33 Now, this one's kind of gross. In fact, it's like really painful.

02:36 I don't, to look at.

02:38 Luckily, we didn't give you a real photograph of this because it is not pretty to look at.

02:45 But this is an example of osteonecrosis of the jaw.

02:49 Okay, so we know that osteo means bone necrosis means dead of the jaw.

02:58 So look at that bone you have sticking out from the gum line there.

03:01 And now I'm going to give you a very detailed fancy definition of it.

03:06 And then we'll break it down the way us mere humans speak.

03:10 The American Society for Bone and Mineral Research.

03:12 Now, these are the experts.

03:14 Here's their formal definition of osteonecrosis of the jaw.

03:18 An area of exposed bone in the maxillofacial region that is not healed within eight weeks after identification by a healthcare professional.

03:27 In a patient who was receiving or who had been exposed to biphosphonate and has not had radiation therapy to the cranial facial region.

03:37 Okay, what does that sound like? One of your textbooks I know.

03:42 So let me give you some study pointers on how you break that down.

03:46 First of all, look at that picture.

03:48 Get a visual of what that looks like.

03:51 That is clearly not normal.

03:54 What's the title or the name of this problem? Osteonecrosis of the jaw.

04:00 So we know there's bone death of the jaw.

04:03 Now you look at the text.

04:05 Okay, so it's an area of exposed bone. Check.

04:09 We got that, right.

04:10 We can see that from the picture.

04:12 Now it's in the maxillofacial region.

04:13 If you don't know where that is, when you're reading, pause, Google it, look it up.

04:18 And you can tell here that it's obviously in the face.

04:21 It's hasn't healed for how long? Eight weeks after who's identified it? A healthcare professional.

04:29 Okay, so put that in your own words.

04:32 Pause for just a minute.

04:34 Take that fancy detailed definition, like you'd see in a textbook and break it down.

04:40 Write it out in your own words on your notes.

04:45 Okay, good work. I hope you did that.

04:47 Because that's one of the most important skills and getting your test questions, right.

04:51 Is breaking the wording down putting it into your own words, and then you're going to do much better on your tests, I promise.

05:00 So you've got that.

05:02 We know that it's exposed bone, it's dead bone, it's in their jaw, and a healthcare professional has looked at it.

05:08 But two months later, it's still not healed.

05:12 Also, the patient had been receiving or has been exposed to biphosphonate.

05:17 And we rule out.

05:18 They can have had radiation therapy because that could cause the same kind of damage, then we know that this is truly osteonecrosis of the jaw.

05:27 Now, pause the tape again.

05:29 I want you to write out, what are two to three criteria for something to be diagnosed osteonecrosis of the jaw.

05:38 I promise you, do it now and it's going to help it really stick in your mind.