FRACTURE: Nailing as a very feasible option in geriatric hip fracture management
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pre op xray distal end radius
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pre op xray distal end radius
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post op xray distal end radius
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post op xray distal end radius
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post op xray proximal femur
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pre op xray proximal femur
We are presenting a case of 72 yr
old moribund patent. The patient had multiple medical problems and was walking
with walker only. He had a fall in bathroom following which he sustained
comminuted fracture left peritrochanteric region and comminuted fracture left
distal end radius. The patient was counseled for surgery but surgery was
possible only after adequate optimization of the patient medically. After 5
days, patient was cleared by anesthesia team only for short duration surgery
with minimum blood loss. Patient was taken to operation theatre and under
spinal anesthesia; long proximal femur nail was inserted. This kind of fixation
allows stabilization of fracture using small incision and with minimal blood
loss. The overall morbidity due to surgery is reduced and patient can be
mobilized early. This patient was allowed sitting and side turning next day
onwards, minimizing risk of deep vein thrombosis and bed sores. The distal
radius fracture too was fixed with k wires only. Plaster was given for 6 weeks
on wrist. There is some debate on the
length of nail used. Shorter proximal femur nails are available where distal
locking can be done using zig, thereby decreasing radiation exposure and
further shortening surgical time. However, reports also suggest that such nails
have shorter lever arm, increasing chances of implant cut out at distal end and
postoperative mid anterior thigh pain.