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Abstract: During indoor walking, the patient fell due to vision loss and muscle weakness of the lower extremities, resulting in sudden pain in the hip joint, inability to stand and walk alone, shortening of the lower extremities, and external rotation of the ankle. A fracture of the femoral trochanter was confirmed by X-ray examination. After admission, she was treated surgically, and the fracture end was stabilized by internal fixation with a proximal femoral intramedullary nail, which also restored the hip joint movement.
Basic information】Female, 70 years old
Disease Type】Intertrochanteric fracture of femur
Hospital】Harbin First Hospital
Date of consultation】December 2021
Treatment plan】Surgical treatment (internal fixation of the proximal femur with intramedullary nail) + rehabilitation training
Treatment period】7 days of inpatient treatment, 3 months of outpatient follow-up
Results】Hip function was significantly improved and range of motion was restored.
I. Initial consultation
The patient was older and had reduced vision, weakened hip muscles, poor coordination of the limbs, and muscle weakness of the lower limbs. She fell down while walking on a slippery bathroom floor and had an abnormal local fracture deformity and limb shortening, resulting in sudden pain in the hip joint, inability to stand and walk alone, shortening of the lower limb, and external rotation of the ankle. A hip radiograph was taken after consultation to confirm the intertrochanteric fracture of the femur, which was consistent with the clinical diagnosis.
Conservative treatment required continuous traction for several months, and the patient was unable to turn normally, which made it easy to form bedridden complications such as decubitus ulcers. Therefore, the patient was advised to consider surgical internal fixation treatment to restore hip joint movement and lower extremity weight bearing as soon as possible and prevent complications such as lower extremity deep vein thrombosis and crushing pneumonia. Since the patient is in relatively poor physical condition and has malnutrition, it needs to be corrected in time before surgical treatment to minimize the risk of surgery.
II. Treatment process
The patient opted for surgical treatment after careful consideration, and after preoperative nutritional adjustment, the surgical requirements were met. During the operation, misalignment of the broken end of the intertrochanteric fracture was confirmed, and the shortened deformity of the lower limb was corrected by lower limb traction, and internal fixation was performed with a proximal femoral intramedullary nail to restore the alignment of the fracture end. Under intraoperative fluoroscopic observation to ensure the stability of the fracture end, the lower limb traction was removed and the hip joint was moved passively. Nursing care was started immediately after the surgery, such as massaging the calf muscles to accelerate blood circulation in the lower limbs and prevent deep vein thrombosis. Under the guidance of the rehabilitation physician, hip flexion and extension activities were gradually carried out to restore the range of motion of the hip joint.
III. Treatment effect
After internal fixation of the proximal femoral nail, the patient’s hip pain was significantly relieved, the shortened deformity of the lower limb and the displaced deformity of the hip fracture were corrected, and the hip joint could actively perform flexion and extension activities, and could turn over on its own to change the sleeping position. The affected limb was able to stand or walk with weight under the protection of double crutches, and although mild pain symptoms occurred, the patient could tolerate them. At 7 days of hospitalization, the patient’s hip function was significantly improved and he could gradually resume basic life, so he was discharged from the hospital. 3-month outpatient follow-up showed that the patient had recovered well and the range of motion of the hip joint had returned to normal.
IV. Notes
The patient’s recovery was very good, and we were sincerely happy for him. The patient was advised to pay attention to the lower limbs, especially the calves, after discharge, and if there is swelling, it is necessary to review the coagulation items and other examination indexes, as well as the vascular ultrasound of the lower limbs, to confirm whether deep vein thrombosis has formed in the lower limbs. In daily life, we should move the muscles of lower limbs more often to speed up the blood circulation of lower limbs through muscle contraction to prevent lower limb DVT. In addition, calcium-containing foods, such as various kinds of meat and eggs, should be increased in the diet, and the sunshine time should be increased to promote vitamin D synthesis and accelerate calcium deposition to promote fracture healing. It is best not to use the affected limb for full weight bearing until the fracture is completely healed to avoid slowing down the healing of the intertrochanteric fracture.
V. Personal insight
The patient fell in her old age and frailty, and the intertrochanteric fracture occurred under the action of torsional forces. For this patient, the risk of bed-ridden complications is greater than the risk of the fracture itself, so surgery is indeed the more appropriate option. Femoral intertrochanteric fracture is the site of osteoporosis in this patient, so the patient should pay attention to protection in ordinary life, wear non-slip shoes and make sure the ground has some friction to prevent hip fracture including femoral intertrochanteric fracture.