Fracture of a rib

[Manresa]

Dignity Sanych!

There lives my grandmother of 75 years... The Osteoporosis has. She went on an apartment, has stumbled about kovrik in a corridor, has fallen, and has probably broken a rib...

Also does not wish to go to the doctor and to do or make a picture...

Pleura the whole, sosnerv a fascicle will not mention or touch, the ledge under a mammary gland in 4-5 sm from a breast bone and a pain in this place is palpated at a prelum of a thorax from sides.

I wish to ask, it is necessary it or her ugovarit on visiting of the traumatologist?

[Dr. the Minstrel]

Alexander Aleksandrovich, excuse, that I respond Aleshe before YOU. Alesha .esli the problem with the grandmother really excites YOU, it or she should be solved and concerning an osteoporosis (is, no what to do or make) both concerning kovrika (to clean) or remove) and concerning falling (Phenazepamum?).

I advise to discuss questions, .posle the answer of a moderator (once again apologies-th these endocrinologists.......)

Or on bodies 124-43 L.JA Rozhinskaja .libo on bodies 248-38 - 66 T.F.Brehunenko.

With the best regards and to YOU, and the grandmother.

[hRuX]

Thanks for additions.

Such consultations only I welcome.

I shall answer an asked question.



If state of health really normal to doctor to go not necessarily, especially clinically you surveyed it or her at a level of the normal expert.

In treatment of fracture of a rib or a bruise of a thoracal any difference is not present.

As to treatment of an osteoporosis is the problem which is beyond traumatology-orthopedics. Personally at me concerning many medicines and methods of treatment of an osteoporosis, and in general in the approach to this problem is, we shall tell or say so, a dissatisfaction.

Success.

[Lexa]

Thanks for a response Dignity Sanych. I only study - a priority for you.

Galina Afanasevna. Several years ago there was compression fracture Th12. After exception of everything, the osteoporosis has been declared. Accepts CaD3-. Kovrik it is cleaned or removed! About Phenazepamum, thanks, did not know, important.

Thanks!

In general, my grandmother - the whole set of illnesses or diseases, here only to treat them it is difficult...

*gt; if the problem with the grandmother really excites YOU

And why you doubt?

[vadglad]

I agree with Doctor Artemyev, at me too a dissatisfaction in a subject of treatment of an osteoporosis. Unfortunately at many doctors the impression was made, that the only thing lechechiem it or this this treatment of fractures, instead of their prevention is extreme rasprostrjaanennogo diseases.



You could not, Doctor Artemyev to develop the idea on a dissatisfaction to the approach to this problem? Whose approach does not satisfy you?



Yours faithfully,



The divisional.

[Anna To.]

Did not wish to conceive discussion, but is a few or a little;little bit time.



1. If to approach or suit formally the diagnosis the osteoporosis can and should be put only on the basis of objective research of the concrete patient (or simply person) with use special, enough dear or expensive equipment (special rentgenustanovki, densitometers or, for example, KT, research on which allows to define or determine density of an osteal tissue).



2. At the same time it is unconditional, that on set of indirect attributes (age, the general or common or local diseases and so forth) it is possible to assume in absentia presence of an osteoporosis at the certain group of the population. Just as the atherosclerosis can be put to any person is more senior 60 (absolutely successful example can, not, but has not occurred better).



3. From here the rational approach to the decision of this problem demands its or her treating within the limits of well we shall tell or say so, all state - as a vaccinal prevention epidem diseases.

Prophylaxis the-general, and treatment (at objective diagnostics - individual (in view of metabolic processes an organism, usvaivaemosti in the necessary parts of a skeleton of the necessary trace substances and pr)

But it cannot cause or call interest, as mentions or touches;affects the most unpromising layers of the population - elderly and old men besides will extend with it or him still a life, having caused or called new problems. And it, believe, nobody is interesting.



4. Actually all this looks or appears as aggression on the domestic market of new chemist's branch, and is shown in use for treatment of preventive preparations, in clinical (I emphasize - clinical, instead of laboratory) which efficiency anybody especially and does not work to be convinced.



5. Having experience above an average in treatment of fractures and cultivation of a bone, in particular, at elongation, I (and all my colleagues will join) never can tell or say, how the given concrete person will have a process of an ossification - quickly or slowly. The most objective statistics on greater or big files gives only the general or common digits, and individually - is not present. Differently, process of loss or conservation of an osteal tissue at the concrete person now gives in not only corrections, but even to an objective estimation.

[Dinar]

Alesha, certainly, ??oa*quot; If it is valid o??ONO*quot; is easier attack of evening medical despair (day of conversations, including with relatives of patients is ended).

Calcium Dz Nikomed (or any other combination of a calcium and Dz-it good prophylaxis, but hardly treatment.

I usually result or bring such explanation - you have bricks for construction summer residences (calcium), there are unskilled workers who will provide transport of these bricks (the active form of vitamin Dz), but are not present vykokokvalifitsirovannyh workers .kotorye will provide construction of the house (remodelirovanie bones)-is not present bisfosfonatov or miakaltsika.

L.JA. ROzhinskaja which bodies I have specified - one of leading experts of-endocrinologists on an osteoporosis, uch. The secretary ?OO?a?a*quot; the Osteoporosis and osteopathies *quot;. Magazine as a whole to .-mine .neplohoj.

[Izutova]

It is published: the Melon





I usually result or bring such explanation - you have bricks for construction summer residences (calcium), there are unskilled workers who will provide transport of these bricks (the active form of vitamin Dz), but are not present vykokokvalifitsirovannyh workers .kotorye will provide construction of the house (remodelirovanie bones)-is not present bisfosfonatov or miakaltsika



.



I have in another way cast a little.

Belkovosvjazannyj the calcium (only such has chance to be acquired) - in a combination with any carrier or bearer is a building material, which in advanced age (and in juvenile and so very well) should close up holes in a skeleton (it is possible to name their most vulnerable zones - for example, shejka femurs).

But there he cannot be delivered on changed or to completely obliterated vessels.

Let its or his concentration will increase in a blood (Serum or where there still define or determine laboratory assistants), let he even will be postponed in good krovosnabzhaemyh parts of a skeleton (let there will be bones of a skull) - he there not very much and it is necessary. He is necessary in shejke femurs (from even it is impossible to present what is an awful and unsoluble problem, ask to believe), namely there the calcium (even the most fine and connected with all best substances) simply well cannot get in any way. It also defines or determines clinical value or meaning;importance. Firms, how much or as far as I know, bear or take out on a board just laboratory parameters or a densitometry of insignificant bones, for example wrists.

Reliability of researches should be proved by depression of quantity or amount of the pathological fractures caused by an osteoporosis in homogeneous groups of patients (with all there statistical pribambasami).

[oxana1972]

Dear Doctor Artemyev, whether you confuse avoskuljarnyj a necrosis of a head of a femur to an osteoporosis?

[Dashka]

izvijajus, avaskuljarnyj.

[Katerrina]

You in a course that such an osteoporosis?

[alenka911]

To the divisional:

1. I do not confuse;

2. In a course.

[Natika]

So it is necessary to advise Alexey concerning prevention of fractures at its or his grandmother?



The osteoporosis can at it or her?



To not fall? Can you how the doctor, can still or even something offer?

[GONOVMR]

Alex, explanations of the reasons of development of an osteoporosis (primary and especially secondary) are very far from what are resulted or brought by you.

Classifications of an osteoporosis and osteopeny and definitions of these statuses, and also criteria of the diagnosis are developed as the CART, and European by group on an osteoporosis.

I in a little bit inconvenient position - in fact we do not conduct discussion at once on ten positions (criteria of the diagnosis., .patogenez, optimization of screening a-beam, a heel, a parity or ratio of a lesion of various sites of a skeleton, improvement efektivnosti diagnostics, etc.)

While I ask to believe, that predstavlenaja you the scheme or plan of a pathogenesis does not maintain criticism .ubezhdena, that you and without my help will find more modern representations-or to you so protiven magazine *quot; the Osteoporosis and Osteopathies *quot;? If he protiven .u Rozhinskoj already pereizdana its or her book on an osteoporosis - on-mine, very nice.....

If a problem of fracture shejki femurs (as we participate in several programs on an osteoporosis and even if we would not participate .polnostju I divide or share;part your alarm in this occasion) was impossibility of delivery of a calcium on ateroskleroticheski to the changed vessels - that, will agree, the decision would lay in a plane-, fibraty .operatsii....

At issldeovanii the modern preparations influencing on osteal remodelirovanie the CALCIUM in the majority of reports goes as platsebo.

[lyosha]

I with the big reluctance was involved in reasonings on a problem of an osteoporosis in which myself as the expert I do not consider or I count.

Moreover, has supported or maintained your first answer to Alexey.

The magazine named by you to me not protiven, I am simple not in a status it or him to study or investigate, just as it is a lot of others, certainly, useful editions.

Books (import) somehow poilstal, but has agreed to differ, which has stated.

Besides I in fact have expressed, we shall tell or say so, the surgical attitude or relation to a problem.

Compare the attitude or relation to a peptic ulcer of gastroenterologists (therapists) and, I do not know as to name, let will be gastric surgeons.

Behind this I leave or abandon a field of not fastened fight...:)

[vasiliy_vpss]

Alex, I hope .my friends, I .vo any case, very much value your opinion.

[Olga]

Alexey! Describe a little bit more in detail a case history of the grandmother what medicines she accepts. Unfortunately orthopedists do not consider or count themselves as experts in an osteoporosis, sounds certainly as kolambur but though show alarm and that is good.

[goldy ira]

It is published: the Melon

Alex, I hope .my friends.

Yes.

It is touched and even it is flattered (quite seriously).

[Golovch]

It is published: Libman-Saks

Unfortunately orthopedists do not consider or count themselves as experts in an osteoporosis, sounds certainly as kolambur but though show alarm and that is good.



Eh, misters and ladies.

As you are able to injure deeply. Sat easy, was engaged...



I shall dare to quote S.S.Judina (I hope, heard about such):

*quot; One operate cancers of a uterus and complex or difficult pyeses of its or her appendages; others treat women irrigations, greasings and wads. Both those and others - experts-gynecologists.

One tie up or dress cerebral sine and open the intracranial abscesses complicating an inflammation of a middle ear, delete cancers of a larynx; others treat rhinites intranasal greasings or improve voices of singers and singers fragrant inhalations. Both those and others - experts--laryngologists. And quot;



You to itself carry yourselves?

[Dolphin]

Alexander Aleksandrovich!

To you the sin to complain. If to esteem, everything, that at this forum it has been stated in my address it is difficult to understand how still the ground holds such monster.:)

[Dred]

Alexander,

The citation from Yudin has liked me. However there is one more moment. Some our colleagues can get surgically anywhere and make everything, sshit everything and with everything, replace with one another and another the third. But the trouble consists that they often plainly do not know when and what for it is necessary to do or make it and necessary-whether, at existing less extravagant alternatives, to do or make in general. And thus they, possessing good arms or hand and hir. Technics or technical equipment, obviously do not consider or count itself ordinary. I cannot this phenomenon so ingeniously to formulate as SSJU, but I mark or celebrate it or him not less than a phenomenon, to it or him;them described. Greetings to you big

[Cotya]

Hi Alexey (all Alexeys) and is simple all.

The subject interesting (I not about fracture of a rib) but to develop it or her to me in the near future, probably not udastsja (in a deep time trouble).

Nevertheless...

To conceive dispute in occasion of who is as a children's plot - who more strongly - the boxer or the karateka more cleverly or more necessary.

I know surgeons at whom arms or hand run ahead of a head, I know therapists who behind clever ideas and phrases do not see the patient. I know simply rafinirovanyh scientists (in greater or big scientific grades), and all of you them know.

There is a science, there is a practice, there is a concrete doctor, there is a concrete patient.

Unfortunately, not always all this converges in one place and during one time.

Always yours.

[panzer]

Surgical creativity by all means develops of two various elements: rukodejstvija and scientific thinking. One without another will appear fruitless



Sergey Sergejvich Yudin



If someone closely or attentively read someone *quot; Etudes Gastric o?OOOu??*quot;, has paid attention, that Sergey Sergeevich the first has come out with the assumption of the infectious nature of a peptic ulcer. Blagodorja to the last the peptic ulcer practically does not meet here and there. And here and there it simply epidemic as result of this sterility or barrenness.



It I to you as the surgeon-surgeon.

[natana]

I with friends watch or keep up discussion of colleagues. We are surprised with the approach of some experts to a trade of the doctor. Not so long ago the Oncologist has declared, that he is not interested in a question of the prevention or warning of a cancer of a breast because he... The oncologist. It as Giljarov would tell or say that he is not interested in a stenocardia, because he... The cardiologist. Or doctor Melnichenko has told or said, that the question on iodic prophylaxes of its or her struma does not interest, because she... tireidolog. It seems to me, that doctors Artemyev the question of an osteoporosis, though he should interest and... The orthopedist-traumatologist. To it or him;them in fact the patient with an osteoporosis and fracture also has addressed!

[Enigma]

Certainly, the situation resembles a pun more, but, it seems to me that to shame each other is not the most effective way to help or assist Alexey with its or his question.



Alexey, you as I have understood, the student and your question on fracture of a rib at an osteoporosis is a good occasion to understand this widespread disease. What a speciality you have selected or elected in the future, whether it be the gynecologist or the therapist, to you will come elderly patients with history of fractures.



I liked a question set Libman-Saks: she accepts what preparations. It is one of questions at issue by way of the prevention or warning of the further fractures.



Yours faithfully,



The divisional.