Mrs. McKenzie Scenario

Mrs. Lucille McKenzie Scenario



Mrs. Lucille McKenzie Scenario

Introduction

Treatment of fracture in the elderly remains controversial, and, in general, fractures treatment is done by non- surgical methods in this group of elderly patients. However, some fractures are very unstable, and non-surgical treatment can be difficult. Surgery in the elderly carries an increased risk of health problems pre-existing osteoporosis, which can prevent stable fixation and healing wounds thanks to the quality of the soft tissues around the bone (Boonen, 2004, 113-115). High rates of postoperative complications have been reported in elderly patients with infection in 12% of patients. Osteoporosis often hampered by a stable fixation with unsatisfactory results in 42% of cases (Cockerill, 2004, 44-47). Thus, surgery is not recommended in patients over 50 years. On the other hand, Nilsson has shown that open reduction and internal fixation (ORIF) in the elderly are a better anatomical matching produces better results than nonsurgical treatment (Marrs & Lowry, 2009, 3-12). Leach and Fordyce reported no failures due to poor bone quality parameters. As part of this controversy, we reviewed the initial results and complications of internal fixation of fractures in patients over 70 years.

Discussion

Mrs. Lucille McKenzie is a 72 year old lady. Three weeks ago Mrs. Lucille McKenzie (72) was admitted to her local hospital after a fall that resulted in a broken bone, severe bruising and a degree of disorientation. Her partner Sophia reported to the admissions team that Mrs. Lucille McKenzie had tripped on the stairs. She also said that Mrs. Lucille McKenzie had been quite forgetful for some time and that more recently her moods had changed sometimes she would become quite angry and then almost childlike.

On the ward, staff have found Mrs. Lucille McKenzie quite passive and reluctant to ask for help even when needed assistance to get to the bathroom. Sometimes Mrs. Lucille McKenzie asked if her mother would be visiting, and where exactly was she? Her mother had died 5 years earlier. Mrs. Lucille McKenzie gradually became more mobile sometimes walking to parts of the hospital, where she completely lost and unable to find her way back on her own ward. Sofia visited daily in the evenings and Mrs. Lucille McKenzie always seemed pleased to see her, although some heated exchanges where observed. Mrs. Lucille McKenzie explained to the sister that Sophia is under a lot of pressure at work, and worried that she may lose her job. Sophia travels by train every day to work and with poor health from chronic chest condition due to heavy smoking, her absence at work has been commenting. Mrs. Lucille McKenzie also said, during her initial assessment that she (Mrs. Lucille McKenzie) had been working part-time in the cafe at a local garden centre; however, they had been explaining to her that she probably should retire as she was often missing her shifts, and arriving on the wrong days.

Rib fracture

A rib fracture is basically a split or crack in a rib bone. The ribs are that part of the bones ...