A 76 frail lady presented with pain and deformity of the Right lower limb, following a slip in the bathroom. Xray revealed intertrochanteric # i.e. fracture of the hip bone. The patient was a little disoriented and their blood sugar was high
At this age, unless immediate measures are not taken, this type of fracture may lead to ultimately death of the patient.
All efforts should be focused on making the patient walk immediately
The electrolyte imbalance, because of which the patient was confused, was corrected promptly.
Her blood sugar was controlled with inj. Insulin and she was well hydrated and stabilized within 24 hours. Within 36 hours of presentation after injury, she was operated and a special nail which allows to stand and bear weight partially was successfully inserted. Within 24 hours after surgery, she was out of bed and ambulating with a walker. The patient was discharged within 5 days.
The story does not finish here. Four hours after the first fracture, she again sustained an injury, this time to her right shoulder. The old couple stays alone and we’re dependent, unfortunately, on household help for day-to-day activity. This time, she had suffered a very severe fracture of the shoulder ( neck of the humerus) with multiple fragments. Because of advanced osteoporosis, the bone was very weak and no plate or screw could have provided adequate fixation. A decision was taken to replace the shoulder, after discussing it with available relatives and her husband. A reverse shoulder replacement was Performed and we were able to send her home, after 4 days, completely pain-free with the arm in an arm pouch. Stitches were removed at 2 weeks and physiotherapy was instituted. Within 6 weeks she had a functional free range of movements.
