DJ Moore; BMJ Case Report: 2012; Sequential bilateral femoral fractures

Sequential bilateral femoral fractures

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7361 (Published 14 November 2012)

Cite this as: BMJ 2012;345:e7361
  1. Seyed Ali Moeinoddini, foundation year 2 trainee, orthopaedic surgery1,
  2. Rajkumar James Parikh, consultant geriatrician1,
  3. Sarah Ruth Moore, specialist registrar, rheumatology and general (internal) medicine 2,
  4. David James Moore, consultant radiologist 3

A 78 year old woman presented to the emergency department with an off-ended, shortened, anteriorly deviated, long oblique fracture of the right femoral diaphysis. She had been experiencing thigh pain for several weeks before this acute presentation and analgesia had been prescribed.

She described feeling the bone “crack” as she turned around. There was no history of trauma. The fracture was surgically treated with an intramedullary nail.

Six months earlier she had sustained a similar fracture of the midshaft of her left femur. Again, there was no trauma and she described feeling the bone “crack” as she twisted slightly to go through her front door. She was unable to reach a telephone to call for help and spent some time on the ground before a passer by called an ambulance. After initial treatment with a Thomas splint, she was treated surgically with an intramedullary nail. After two weeks of rehabilitation she returned home to live independently and was able to go out with one stick to do her shopping.

Her medical history included osteoporosis and hypovitaminosis D. The diagnosis of osteoporosis was made after she sustained a vertebral crush fracture. She had been receiving bisphosphonates to prevent further fractures for nearly five years.

Questions

  • 1 Why are such fractures described as “atypical”?

  • 2 What underlying mechanism might explain such fractures?

  • 3 What are the main clinical and radiological features of atypical femoral fractures?

  • 4 How would you investigate her thigh pain?

Ralte, P, Grant, S, Withers, D, …Waseem, M

Intramedullary fixation of diaphyseal clavicle fractures using the Rockwood clavicle pin: a review of 68 cases

P Ralte,  S GrantD WithersR WaltonS MorapudiR BassiJ Fischer and M Waseembone_and_joint
Orthopaedic Proceedings: The Bone and Joint Journal 2012 – bjjprocs.boneandjoint.org.uk
Purpose Plating remains the most widely employed method for the fixation of displaced diaphyseal clavicle fractures. The purpose of this study was to assess the efficacy and outcomes of diaphyseal clavicle fractures treated with intramedullary fixation using the Rockwood clavicle pin.

Lucas, A; Continuing professional development, friend or foe?

alucas

Published in British Journal of Midwifery, Vol. 20, Iss. 8, 02 Aug 2012, pp 576 – 581

This article demonstrates processes used by managers to identify learning needs including the attainment of competencies, self assessment and appraisal. 

Adamson et al (1998) suggests that a career is not just about what one does for a living, but about what one has done in the past, does now and might do in the future. Sennett (1998) concurs, relating a career to a ladder to be climbed to reach a desire for status and fulfilment. It is also believed that the learning process should be prominent in career planning (Mumford, 1990)—indeed acquiring new skills has enabled me to develop into my current role as a ‘functional‘ manager (Charan et al, 2001).learning methods are reviewed as the author reflects on the importance of continuous professional development within her organisation.

My career pathway has changed from being purely clinical as a Labour Ward lead, to containing increased elements of management especially after my promotion to Deputy Head of Midwifery. The change in direction was the result of choices which involved self-awareness and self-efficacy, and were consistent with where I saw my role in the future.  …… Full article requires Athens account 

Amanda Lucas
Deputy Head of Midwifery and Women’s Services/Supervisor of Midwives,
Macclesfield Hospital,
East Cheshire NHS Trust

Noormohamed, MS, Neophytou, C, Jain, Y; BMJ Case Reports 2012

A 66yearold male with lower abdominal lump: an unusual presentation of an uncommon abdominal pathology

MS Noormohamed, C Neophytou, Y Jain… – BMJ Case …, 2012 – casereports.bmj.com
Summary A 66-year-old Caucasian male was admitted following symptoms of intermittent umbilical pain aggravated after meals and associated with vomiting of contents. Physical examination revealed a tender, partially reducible swelling suspicious of complicated umbilical hernia. Abdominal x-ray revealed dilated small bowel loops which appeared consistent with clinical diagnosis. He underwent a laparotomy subsequently which revealed a small defect in the linea alba with viable small bowel and two firm mesenteric masses encroaching the lumen approximately two feet from the ileocaecal junction. The histology of the excised bowel and masses revealed that the tumour composed of bland spindle cells with slender to plump nuclei and eosinophilic cytoplasm. Mesenteric fibromatosis are the most common primary tumours of the mesentery and constitute about 3.5% of all fibrous tissue tumours. Intra-abdominal desmoids are very rare and benign tumours but are very aggressive and should be considered in the differential diagnosis of acute abdominal pain.

Amin,K, Jain, Y, Clarke, L, Roshanlall, C – European Journal of Surgical Oncology; 2012

Incidence of local and distant recurrence after mastectomy-a ten-year review at Macclesfield District General Hospital (MDGH)

K Amin, Y Jain, L Clarke, C Roshanlall – European Journal of Surgical …, 2012 – ejso.com
European Journal of Surgical Oncology Volume 38, Issue 5 , Page 427, May 2012.
Incidence of local and distant recurrence after mastectomy – a ten-year review at Macclesfield District General Hospital (MDGH). 
No abstract available.

Patient satisfaction following mastectomy and breast reconstruction in a district general hospital

Y Jain, K Amin, J Kokan – European Journal of Surgical Oncology, 2012 – ejso.com
European Journal of Surgical Oncology Volume 38, Issue 5 , Pages 429-430, May 2012.
Patient satisfaction following mastectomy and breast reconstruction in a district general hospital. 
No abstract available.

BMJ Learning modules for this week

Common problems in children 5: skin conditions

The following modules give an important update on a range of common dilemmas.

Caring for patients with bowel symptoms: in association with the NHS Cancer Screening Programmes

Suspected breast cancer: when you should refer – in association with NICE

Suspected lower gastrointestinal tract cancer: when you should refer – in association with NICE

Suspected lung cancer: when you should refer – in association with NICE

AQuA: forthcoming February events

These AQuA events are starting soon – have you booked your place?

31 Jan 2013
Advancing Quality Cheshire and Wirral CCGs locality meeting (part of Reducing avoidable mortality)
GPs and commissioners from across the Cheshire and Wirral cluster are invited to attend a locality meeting to discuss the role of CCGs in Advancing Quality (AQ). Advancing Quality is a clinically-led quality improvement programme designed to driv…

31 Jan 2013
Motivational Interviewing (part of Better Patient Experience)
See attached document for a summary of the Event and alternative dates.

04 Feb 2013 — 04 Feb 2013
Human Factors of the AQuA Improvement Methodology Plus programme

08 Feb 2013
Children & Young Peoples (part of Quality of life for people with long term conditions)
Avoiding unnecessary Hospital Admissions and inappropriate A&E attendances of Children & Young People with Long Term Conditions Following the successful launch in September, we would like to invite you to Workshop 2 of the Children & Young People’…

08 Feb 2013
Shared Decision Making – Train the Trainer (part of Better Patient Experience)
Learning Objectives are to: Increase the awareness of SDM in clinical environments Provide tools and examples of SDM language that could be used Identify potential challenges around engagement and identify solutions. Agenda Setting the scene In…

13 Feb 2013
Action Learning Set 3 (part of Integration)
Third Action learning set for the Integrated Care community 2

14 Feb 2013
Motivational Interviewing (part of Better Patient Experience)
See attached document for a summary of the Event and alternative dates

15 Feb 2013 — 15 Feb 2013
Coaching Essentials of the AQuA Improvement Methodology Plus programme
There is a half day follow up with this module which will be held on 21st March 2013 am.

15 Feb 2013
Motivational Interviewing (part of Better Patient Experience)
See attached document for a summary of the Event and alternative dates

22 Feb 2013
Motivational Interviewing (part of Better Patient Experience)
See attached document for a summary of the Event and alternative dates

25 Feb 2013 — 25 Feb 2013
Measurement of the AQuA Improvement Methodology Plus programme

26 Feb 2013 — 02 May 2013
Cohort Three of the Advanced Team Training Programme in Healthcare programme
Cohort three of the Advanced Team Training Programme in Healthcare

26 Feb 2013
Advancing Quality Programme Leads meeting of 2013 (part of Reducing avoidable mortality)
Ideally, the programme lead (or alternative representative) from each acute and mental health trust participating in the Advancing Quality programme should attend. The meetings are the most beneficial for attendees when we’ve got representation fr…

27 Feb 2013 — 05 Apr 2013
Cohort 11 of the AQuA Improvement Methodology programme

27 Feb 2013
Advancing Quality Greater Manchester CCGs locality meeting (part of Reducing avoidable mortality)
GPs and commissioners from across the Greater Manchester cluster are invited to attend a locality meeting to discuss the role of CCGs in Advancing Quality (AQ). Advancing Quality is a clinically-led quality improvement programme designed to drive…

28 Feb 2013
Unlocking Diagnosis: Sharing Good Practice in the Assessment of people with Memory Problems (part of Quality of life for people with long term conditions)
The focus of this event will be to share good practice in the assessment of people with memory problems and to provide an update from the Memory Services National Accreditation Programme