Orthopedics Today, May 2017
Eric M. Cohen, MD; Shaun P. Patel, MD; Valentin Antoci Jr., MD, PhD
A 77-year-old woman, who was found down at her home, was brought to the hospital by ambulance. Her mental status was altered. The patient’s medical history was significant for chronic obstructive pulmonary disease, oxygen at home (2L nasal cannula) and type 2 diabetes mellitus. She was underweight (BMI 17.2), and was taking opioids for chronic low back pain. Seven months earlier, the patient had fallen and reportedly had a right hip fracture at the time. She had been recovering well as a household ambulator who used a walker, but she continued to have baseline pain that was mostly associated with her back.
At admission, the patient’s labs were significant for a peripheral white blood cell count of 13.3 x 109/L with 85.7% neutrophils, lactic acid of 1.6 mmol/L (normal, 0.2 to 2.2 mmol/L), C-reactive protein of 61.7 mg/L (normal 0 mg/L to 10 mg/L), erythrocyte sedimentation rate of 51 mm/h (normal, 0 mm/h to 30 mm/h), hemoglobin of 12.3 g/dL and glucose of 241 mg/dL. A CT scan of the abdomen and pelvis with IV contrast showed mild thickening of the distal sigmoid colon, which possibly represents early colitis, as well as a previous right basicervical femoral neck fracture with bone resorption and an enhancing joint effusion (Figure 1).