Simultaneous Bilateral Hip Fractures in an Elderly Patient in the Absence of Bone Disease: A Case Report

Case: Eighty-three years old female patient who sustained a simultaneous bilateral hip fractures after a mechanical fall. The bilateral nature of the problem was not appreciated by the emergency team and was found after the orthopedic consultation. The patient underwent a single stage bilateral cemented bipolar hemiarthroplasty without perioperative complications. Conclusion: Simultaneous bilateral hip fractures in elderly are not commonly encountered after a low energy mechanism but early recognition of this diagnosis is important to optimize perioperative management. Having bilateral cemented stems did not lead to any significant cardiopulmonary complications as can often be concerned with so called cement syndrome.

Cemented Bipolar Hemiarthroplasty for Fracture Neck of Femur and Unstable Intertrochanteric Fractures - Prospective and Retrospective Study

Hip fractures in elderly patients are becoming a major social problem from various perspectives, including the progressive aging of global societies. The elderly have a high risk of hip fracture, even with minor injuries because of osteoporosis, while early surgical treatment may be difficult due to comorbidities and medication. In this study, significant risk factors were identified. Patients over age 70 had three times the mortality of younger patients. Greater than three pre-existing medical conditions is associated with a 25 percent mortality rate, more than twice that of healthier patients. Surgery performed on the first day of admission and beyond the fifth day was associated with a 34 percent mortality rate. Those patients operated in during days 2 through 5 had a 5.8 percent mortality rate. There was no failures related to inadequate stem or mechanical loosening. The tendency to dislocation can be clinically identifiable by major discrepancy in length, there was no failures related to inadequate stem or mechanical loosening. The tendency to dislocation can be clinically identifiable by major discrepancy in length and only 1 patient had shortening of about 2 cms post operatively which was slightly better than that of James et al (11%).

A Study on the outcome of surgical management of Unstable Intertrochanteric Fractures in the geriatric population by various modalities

Background: Unstable hip fractures in elderly patients a unique challenge for orthopedic surgeons. Most of the cases are to be managed by surgical intervention. The problems of old age include the presence of osteoporosis, pre-existing arthritis, the overall health of the patient. We in the present study tried to evaluate the functional outcome of surgical management of unstable intertrochanteric fractures by various methods and study the effectiveness and complications of the operative management of unstable fractures. Methods: This cross-sectional study was carried out in the Department of Orthopedics, Prathima Institute of Medical Sciences, Nagunur, Karimnagar. All patients with unstable intertrochanteric fractures with age > 65 years who are treated by the surgical intervention were included in the study. All the patients were operated in Spinal anesthesia and The standard surgical procedures were followed for different modalities like DHS, PFN, Enders Nail’s and cemented bipolar hemiarthroplasty was done. Results: Out of n=50 patients n=28(56%) were female and n=22(44%) were males. The average duration of hospital stay was 14 days, with a range of 10-25 days. The mean blood loss in cemented bipolar hemiarthroplasty was 300 ml, PFN 100 ml, DHS was 250ml, and Ender’s Nail was 50ml. In our study of Bipolar hemiarthroplasty out of n=9 patients n=3 (33.34%) had excellent, n=5(55.56%) good outcome, n=1(11.12%) had fair outcomes respectively. Out of n=9 patients of PFN n=4 (44.44 %) of excellent, good n=4(44.44%), fair n=1 (11.12%) patient and no poor results. Out of n=25 patients of DHS n=20 (80%) patients are excellent to good results, n=3(12%) patient had fair and n=2 (8%) patients had poor results. Out of 7 patients of Ender’s nails n=2(28.573) had excellent and n=3(42.85%) had good and n=1(14.28%) fair, n=1(14.28) had poor results. Conclusion: Intertrochanteric Fractures in the geriatric population are a unique challenge it requires early operative management which will reduce both mortality and morbidity. Early mobilization following operative treatment will reduce the risks associated with prolonged bed rest in geriatric patients. Since failure rate is still high in unstable intertrochanteric fractures selection of proper implants is important for the ultimate success of the treatment.