93-year-old woman with a history of COPD, AHT, dyslipidemia, atrial fibrillation and ischemic heart disease. She lives alone. She has ventricular ejection fraction 53%, creatinine 1.5 mg/dL, normal coagulation. She receives treatment with inhaled bronchodilators and ASA 100 mg per day. She suffers a fall in the street, after which it is impossible for her to stand or sit up, with intense pain in the right hip on mobilization, great shortening and external rotation of the leg. When and how should she be treated?
A new approach is currently being developed for the treatment of these patients, which tries to coordinate from the beginning the activity of the different sectors involved, avoiding that the transfer of the patient from one to another takes place at the end of the treatment of each part. This idea gave rise to the so-called orthogeriatric units", which combine the surgeon's surgical activity with that of the patient's immediate rehabilitation and the controls and follow-up of internal medicine. From the very beginning of the process, the social workers and the various vital and support aids are put in place to ensure that recovery is as rapid and complete as possible. ... In most cases, surgery should be performed as soon as possible, as soon as the patient is medically stabilized. There is a contraindication to surgery in patients with unstable medical comorbidity, but several studies have shown that delaying surgery beyond 48 h after admission increases mortality. This is why the ideal time to intervene in these patients is after achieving stabilization of their medical pathologies, taking care that this takes place before 48 h have elapsed." There is no data to suggest that he has any unstable comorbidity at the present time, so surgery in less than 48 hours and orthogeriatric management is of interest.
Admission for transthoracic ultrasound, assessment by Cardiology and then closed reduction and fixation with plate screw.
Admission for evaluation by Nephrology and Cardiology, and then Traumatology will decide whether to use an arthroplasty or a trochanteric nail.
Admission to Internal Medicine / Geriatrics, progressive stabilization of comorbidities, conservative orthopedic treatment.
Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management.
This is why the ideal time to intervene in these patients is after achieving stabilization of their medical pathologies, taking care that this takes place before 48 h have elapsed." There is no data to suggest that he has any unstable comorbidity at the present time, so surgery in less than 48 hours and orthogeriatric management is of interest.