Acute radic + compression fracture

[Timeoutofmind]

Would you tfesi in this situation?

Concern is steroids predisposing to additional/worse fracture.

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[bedrock]

Would you tfesi in this situation?

Concern is steroids predisposing to additional/worse fracture.

when you have concurrent significant radiculopathy, the risk of the TFESI is justified. No radiculopathy, its not justified.

 

[willabeast]

Would you tfesi in this situation?

Concern is steroids predisposing to additional/worse fracture.

i would do the injections.
reasoning as follows.
1. injection likely to increase mobility and standing, which will be beneficial for bone density. bedridden with a Fx because of pain will do the opposite.
2. all the studies i have seen (go ahead and flame me i am retired now) demonstrate worse bone density after steroids if the patient is not taking calcium. if the patient is taking calcium the worsened bone density does not happen after steroids given.
summary - place the patient on calcium and vitamin d (assuming PCP agrees - there are exceptions and other Rx's to improve bone density) and do the injection and get the patient walking and i think you will have helped the patient. this assumes it is not a pathological fracture or an infection.

 

[bedrock]

i would do the injections.
reasoning as follows.
1. injection likely to increase mobility and standing, which will be beneficial for bone density. bedridden with a Fx because of pain will do the opposite.
2. all the studies i have seen (go ahead and flame me i am retired now) demonstrate worse bone density after steroids if the patient is not taking calcium. if the patient is taking calcium the worsened bone density does not happen after steroids given.
summary - place the patient on calcium and vitamin d (assuming PCP agrees - there are exceptions and other Rx's to improve bone density) and do the injection and get the patient walking and i think you will have helped the patient. this assumes it is not a pathological fracture or an infection.

good thorough explanation

Regarding studies of bone density and steroids. Are there any good ones demonstrating significant loss of bone density after a single steroid injection?
Plenty of studies demonstrating bone loss with chronic daily steroid use, but I haven't see one doing dexa scans, a single steroid shot, and then a repeat dexa.

 

[Timeoutofmind]

i would do the injections.
reasoning as follows.
1. injection likely to increase mobility and standing, which will be beneficial for bone density. bedridden with a Fx because of pain will do the opposite.
2. all the studies i have seen (go ahead and flame me i am retired now) demonstrate worse bone density after steroids if the patient is not taking calcium. if the patient is taking calcium the worsened bone density does not happen after steroids given.
summary - place the patient on calcium and vitamin d (assuming PCP agrees - there are exceptions and other Rx's to improve bone density) and do the injection and get the patient walking and i think you will have helped the patient. this assumes it is not a pathological fracture or an infection.

Thanks guys I agree with the thoughts here.

Related question...

What do you think about doing compression fractures if there is a lot of edema but not a lot of height loss? Not to restore height but just to treat the fracture pain. I have a nice lady like this. In this situation would you lean more toward vertebro as opposed to kypho?

 

[lobelsteve]

Kypho for pain, not deformity. i would do esi at time if kypho.