24/03/2025
Three High-Risk Hip Fracture Cases Treated Successfully
A Tale of 3 Hip Fracture Cases: From "Death on Table" Consent to Standing on Their Feet
Hi everyone,
What I’m about to share might sound like it’s straight out of a medical drama, but this is a true story from the operating room. It’s not every day that you encounter three extremely high-risk patients, all requiring "death on table" consent, and operate on them within a span of 24 hours. Two weeks ago, we faced this rare and daunting challenge. The cases included two neck of femur fractures and one peritrochanteric fracture( fracture around hip joint)
Let me introduce you to the patients:
Patient 1 - A sprightly 96-year-old lady (yes, 96 and still young at heart!) with a long list of comorbidities: diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), low ejection fraction (EF), hemoglobin (Hb) of 8.1, and chronic obstructive pulmonary disease (COPD).
*Patient 2: * A 76-year-old male with severe anemia, intraoperative supraventricular tachycardia (SVT), blood pressure (BP) soaring around 200 mmHg, an ejection fraction of just 27%, and oxygen saturation (SpO2) hovering between 80-85%. ( means heart functioning ¼ th of capacity with dangerously high heart rate)
*Patient 3: *A 78-year-old female with CAD, pleural effusion, lung lobe collapse, HTN, and a low EF.( means function of lungs and heart messed up)
As you can see, these cases were as complex as they come. If Shakira says, “Hips Don’t Lie,” for us orthopedic surgeons, “Hips Can’t Lie” because we have no other option but to fix them and at least get these patients back to sitting, if not standing.
Challenges Faced
Each case came with its own set of hurdles: maintaining blood pressure, controlling blood loss, preventing deep vein thrombosis (DVT), managing heart rate, and ensuring stable oxygen levels. It felt like we were in the knockout stage of a IPL , with the patients’ vitals on one side and the anesthesia and surgical teams on the other. Each surgery had its tense moments, but in the end, all’s well that ends well!
Learning Outcomes
The old adage, “If you fail to plan, you are planning to fail,” holds true in every medical scenario. From a surgical perspective, here’s what we did to tackle these challenging cases:
Controlled blood loss and minimized surgical time to reduce patient stress.
Modified cementing techniques: Instead of using a cement gun, we manually mixed and applied bone cement digitally to reduce the risk of emboli.
Alternative grafting: In cases where bone cement was contraindicated, we used morcellized impacted bone grafting to achieve a similar fit and stability.
Teamwork Makes the Dream Work
At the end of the day, it’s all about teamwork. I’d like to extend my heartfelt gratitude to everyone involved:
-Thank you anaesthesia team for your dedication, and my apologies for the sleepless nights.
OT staff, and ICU staff: Your support was crucial in making these surgeries successful.
Physio team and nursing team for helping in speedy recovery
If I’ve missed anyone, please forgive me—it’s been a whirlwind!
