Pathophysiology Case Discussion

Pathophysiology Case Discussion

 

 

Joanna’s Case Study

The case study is about Joanna, a 2-year-old patient presenting with pain in the right leg, emotional withdrawal, and irritability. Joana has suspected tibial fracture and has had a history of prior similar fractures. Currently, she also has evidence of fracture of the left anterior ribs. No history of trauma is evident from her history.

Differential Diagnoses  

Joanna’s bone fractures are most likely spontaneous and therefore, the differential diagnoses include but are not limited to osteogenesis imperfecta tarda B (Subramanian & Viswanathan, 2021), cerebral palsy, juvenile osteoporosis, hypervitaminosis A, renal osteodystrophy, and metastatic disease (Siddiqui et al., 2021). I think she may have osteogenesis imperfecta tarda because of evidence of multiple fractures in the perinatal period. Cerebral palsy often diagnosed before age 3 also present more commonly with multiple bone fractures. Hypervitaminosis among children and adults also presents multiple spontaneous fractures. The chronic renal disease leads to deranged calcium metabolism thus renal osteodystrophy also causes bone disease presenting with spontaneous fractures.  Also, less likely in her age group are bone tumors (Chaib et al., 2021) and metastatic bone disease that would place her at risk of multiple spontaneous fractures.

Evaluation and Management

Making a clinical decision will require the following investigations: a plain radiograph to rule out other bone fractures and density reduction elsewhere in the body, serum calcium and vitamin D levels to rule out metabolic etiologies, serum vitamin A levels to rule out hypervitaminosis A, and bone scan to rule out metastatic bone disease, renal function test to rule out kidney disease a cause of her presentation. A treatment plan for this patient would aim at improving her quality of life and preventing future fractures. Analgesia to manage her pain would be done per the analgesic ladder. Reduction of mobility will give time for bone healing. Splinting will also promote allow normal healing of the bone. Teaching to the patient’s parents will include avoidance of contact sports and increasing intake through dietary modification and supplementation (Trăilescu et al., 2019). Definitive treatment will be determined by the final diagnosis made through the instigations.

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References

Chaib, B., Malhotra, K., Khoo, M., & Saifuddin, A. (2021). Pathological fracture in pediatric bone tumors and tumor-like lesions: A predictor of benign lesions? The British Journal of Radiology, 94(1125), 20201341. https://doi.org/10.1259/bjr.20201341

Siddiqui, Y. S., Abbas, M., Muhammad, J., Sherwani, M. K. A., Khan, M. J., & Yadav, A. (2021). Challenges in the management of benign bone tumors complicated by a pathological fracture in a pediatric population. International Journal of Burns and Trauma, 11(3), 207–219. https://pubmed.ncbi.nlm.nih.gov/34336387/

Subramanian, S., & Viswanathan, V. K. (2021). Osteogenesis Imperfecta. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK536957/

Trăilescu, M. D., Pavel, A. I., Pop, M. A., Zurbău-Anghel, N., Stoica, G. A., Fruntelată, R. F., Singer, C. E., Stoica, M., & Constantin, C. (2019). Pathological fractures of the humerus in children. Therapeutic and pathological considerations. Revue Roumaine de Morphologie et Embryologie [Romanian Journal of Morphology and Embryology], 60(3), 831–840. https://www.ncbi.nlm.nih.gov/pubmed/31912093

 

Overview
Joanna is a 2-year-old who presents at the urgent care clinic with a transverse fracture of the right tibia. On examination, she is withdrawn and
cries when touched by anyone other than her mother. On radiographs, she has had a previous fracture of the right tibia and of the anterior ribs
on the left. Her mother does not recall any accidents that would have produced these injuries.1 Discuss the possible cause of Joanna’s injuries. Develop a list of differential diagnoses with your clinical reasoning for each to share with your classmates. 2. Describe and detail any evaluations you would need to perform to make a clinical decision.
3. Provide a proposed treatment plan for each of your diagnoses.
4. What teaching would you provide to this family?
Include citations from the text, the Shadow Health simulation assignment, and/or the external literature in your discussion posts,
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.