Doger EP, González LJ, King MAC

Language: Spanish
References: 7
Page: 24-29
PDF size: 708.17 Kb.

ABSTRACT

Introduction: The hip fracture is the bone continuity solution in the head, neck or at the level of the greater and lesser trochanter of the hip. Aproximately, 50% of the fractures affect the neck of the femur, 80% occur in women and they occur mainly in adults over 55 years old. It’s important to emphasize that this pathology has a 20-30% mortality within the first year after the injury and more than 50% will be unable to rejoin their daily activities1. The majority of patients who suffer from it have an associated systemic pathology (the most frequent being cardiovascular diseases, respiratory diseases, diabetes mellitus, sensory or neurological deficits, mobility or balance problems, malnutrition and dementia).
Case report study: 22-year-old female with a history of DM Type I diagnosed at age 10, in treatment for a pulmonary tuberculosis diagnosed in December of 2016, and malnutrition. She suffered a fall, starting with pain and limited movement in the leg on the right side. On the directed physical examination: right pelvic member with limited hip arc movement with pain at the level of greater trochanter, presenting clinical shortening of approximately 2 cm and in external rotation of the leg. An AP pelvis radiography was performed where a simple trace at the transtrochanteric level and fragmentation of the lesser trochanter was observed. A closed reduction with internal fixation with an intramedullary nail for proximal femur PF 110 × 75 was performed and was channeled to interconsultation to the departments of internal medicine, psychiatry, nutrition and rehabilitation of the hospital.
Conclusions: Hip fractures are a pathology with a high rate of morbidity and mortality in a period of one year after the injury. They require an immediate surgical solution and a multidisciplinary approach to reduce the incidence of complications. The objective after the treatment is to achieve the same amount of independence and ambulation as before the injury.

REFERENCES

1. Lovato-Salas F, Luna-Pizarro D, Oliva-Ramírez SA, et al. Prevalencia de fracturas de cadera, fémur y rodilla en la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Lomas Verdes del Instituto Mexicano del Seguro Social. Acta Ortopédica Mexicana. 2015;29(1):13-20.

2. Negrete-Corona J, Alvarado-Soriano JC, Reyes-Santiago LA. Fractura de cadera como factor de riesgo en la mortalidad en pacientes mayores de 65 ańos. Estudio de casos y controles. Acta Ortopédica Mexicana. 2014;28(6):352-62.

3. Fernández MA, Griffin XL, Costa ML. Management of hip fracture. Br Med Bull. 2015 Sep;115(1):165-72.

4. Mattos CA, Jesus AA, Floter M, et al. Reproducibility of the Tronzo and AO classifications for transtrochanteric fractures. Rev bras ortop. 2015;50(5):495-500

5. Flevas D, Megaloikonomos P, Dimopoulos L, et al. Thromboembolism prophylaxis in orthopaedics: an update. EFORT Open Rev. 2018;3:136-48.

6. MacReady N. Hip Surgery Delays Increase Mortality Risk in Older Patients. Medscape. August 07, 2018. Disponible en https://www.medscape.com/viewarticle/900339

7. Reguant F, Arnau A, Lorente JV, et al. Efficacy of multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture. Journal of Clinical Anesthesia. 2019;53:11-9.