Physical therapist management and coordination of care to prevent pathological hip fracture from metastatic disease: a case report.
Athena Manzino, Christopher Wilson
PMID 39363992WHAT IT FOUND
One woman with breast cancer bone metastases reported worsening left hip pain with walking during physical therapy.
The therapist reported this to the physician, and imaging and prophylactic hip fixation followed. She later walked 140 feet with a walker at discharge.
Key findings
01The physical therapist reported increasing left hip pain and instability during weight-bearing mobility and contacted the nurse and attending physician.
02Imaging ordered after these concerns showed extensive metastatic disease around the left femoral intertrochanteric region, and the patient underwent prophylactic intramedullary nail fixation with no pathological fracture on the surgical report.
03By discharge, the patient had modified independent bed mobility, standby assist transfers, and walked 140 feet with a rolling walker, and her AM-PAC 6-Clicks score was 18/24.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This is one patient with no comparison group, so it cannot show whether physical therapy, surgery, chemotherapy, pain medication, or occupational therapy caused the outcome. The authors state that conclusions and generalizability are limited because this is a case report. The medical record initially had no mobility restrictions despite a known femoral lesion, so the report shows a care gap rather than a tested solution. The initial x-ray was negative, so waiting for plain imaging may delay recognition when MRI is needed. The paper states that the AM-PAC 6-Clicks measure has not been definitively tested for validity in the oncology population. The paper states that physical therapists are not currently allowed in the majority of jurisdictions to order imaging studies, which can delay tests even when suspicion is high. The report does not compare patients with and without physical therapist recognition, so it cannot measure whether a pathological fracture was prevented.
Declared interests
The authors reported no commercial or financial relationships that could be construed as a conflict of interest.
The easy way to misread this
Do not conclude that physical therapy prevented a pathological hip fracture. This is one case report with no comparison, and the patient also had surgery, chemotherapy, opioid pain control, and occupational therapy, so the contribution of any single part cannot be separated.