Transverse Process Fracture

[NOSfan]

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60 y/o lady s/p fall 1 month ago. CT shows L1 transverse process fracture. PCP braced, bisphosphates, anti-inflammatory and anti-spasmodic. Still c/o unilateral pain at the site.

Your move.

 

[Ducttape]

since I am not seeing her, give the fracture more time.

tho that course might not be applicable for you.

 

[NOSfan]

since I am not seeing her, give the fracture more time......tho that course might not be applicable for you.

What about RF of dorsal ramus or perhaps sympathetic block?

 

[emd123]

Broken bones take more than 4 weeks to heal, especially in a 60 year old, and especially in a part of the body you can't immobilize. This is like a broken ribs. It's going to hurt like hell for at least 6-12 weeks.

Treatment: 4-8 more weeks of time, and nothing additional to conservative care, yet. Reassess at that time.

 

[SSdoc33]

iliopsoas attaches at the TPs, so lifting your leg to walk, changing positions in bed, -- everything really hurts.

i agree. do nothing. i cant imagine the shots would help.

 

[lobelsteve]

Miacalcin. Bid. Brace.
If she complains too much, mri w stir.

 

[emd123]

Miacalcin. Bid. Brace.
If she complains too much, mri w stir.

Good thought. Pain out of proportion to expectations could indicate a VCF not seen on plain films.

 

[DOctorJay]

agree with all above, especially that it hurts and takes a while to heal.

anyone offer short course of opioids for this?

 

[lobelsteve]

agree with all above, especially that it hurts and takes a while to heal.

anyone offer short course of opioids for this?

All day long. 26 pills max before due diligence.

 

[Dr. Ice]

How bout pedicle stress response? Have seen some of these where patient does consistent high impact activity (interestingly two of them have been kickboxing) and they get unilateral axial pain not responsive to conservative treatment.

 

[Ducttape]

not really... short course should have been provided by the doc who first saw, or PCP.