Case of 84 year old female patient presented for left hip trauma

8 posts / 0 new

19 April 2020 - 5:01pm

Horizontal Tabs

History of the Case

Dear colleagues, I hope my mail will find you all well and safe. In the erra of Covid 19 with confinement and social distancing. we found ourselves more than anytime surfing on our smart tablets searching eagerly for answers about this pandemic but also for many ;

it was a good time to surf on the web through the Orthopaedic library.
We are launching today the new FORUM on our website starting with a clinical case which might be straight forward for many and subject of debate for others .
We are asking you , dear colleagues to interact and to give your opinion Looking forward to post on this platform from your side other clinical cases in the near future

Amer Abdallah M.D. Ass. Professor of Orthopaedic Surgery
President elect of the lebanese Orthopaedic society

Dear Collegues, what do you suggest to be done and what are your concerns in such a case?

Patient History

Multiple comorbidities
HTN
DM
Coronary artery disease
Pulmonary hypertension

Thank you so much for your valuable and fruitful comments.
I would like in this Post to give you the follow up to this case and what was the surgeon decision and what happened .
Please comment ; and what would be your next surgical step.

N.B: the patient was not totally compliant to the surgeon recommendation of non weight bearing

N.B. you only need to put your name and comment.
Subject is not mendatory

LOGIN To Post your Comments

Images

Case Comments

24 April 2020 - 11:02pm

member

Can we have the

Can we have the Classification of this fracture?

Khaled Hussein

25 April 2020 - 1:36pm

member

Comments

First, I believe it is a great idea to present such cases as it helps Lebanese doctors to share their knowledge. Referring to your case, it is a subtrochanteric fracture comminuted with disruption of the medial and lateral wall with also avulsion of the greater and lesser throcanter (as shown on the CT scan). In this case, it is best to reconstruct the lateral wall ideally by using either a long cephalomedullary nail, DCS (90 degree) or an anatomical plate. If the patient has a short life expectancy, a reconstructive prosthesis for early weight-bearing and early mobilisation should be considered in order to prevent the complication of immobility. There is a variety of adequate surgical treatments but it should be matched with the patient previous history, presurgical function, her physiological age and other comorbidities. Please keep us posted about your surgical decision and thank you for posting this case.

George el rassi

25 April 2020 - 2:45pm

member

hip case

long gamma nail ps:just for testing the app

alfred khoury

25 April 2020 - 4:42pm

member

Left hip fracture

Reverse oblique subtrochanteric fracture, with posteromedial and proximal lateral wall fracture. This is an unstable fracture, One option is a long Gamma nail, with dynamic screw and anti rotation proximal screw to resist the varus stress. Distal locking using the Static distal locking technique, to avoid loss of reduction. 2 cables proximally to compress the medial and lateral fragments adding to the stability. Human bone graft is an option. Patient should avoid full weight bearing for 3 weeks

Ryad Fakih

5 May 2020 - 11:17pm

member

Long gamma nail plus tsp

Long gamma nail plus tsp plate if concerned about instability due to lateral wall fracture

Elias Esber

5 May 2020 - 11:24pm

member

It’s a comminuted reverse

It’s a comminuted reverse oblique subtrochanteric fracture. I think both a DCS and a long gamma nail are good options. My choice will depend on the comorbodities and the need for immediate weight bearing. Thank you for this forum and hopefully we can discuss more interesting cases.

Bachir Ghostine

22 May 2020 - 1:00am

administrator

Follow up to this case

Dear colleagues Thank you so much for your valuable and fruitful comments. I would like in this Post to give you the follow up to this case and what was the surgeon decision and what happened . ( check the new images added) Please comment ; and what would be your next surgical step. N.B: the patient was not totally compliant to the surgeon recommendation of non weight bearing

Amer Abdallah