Recently, a 95-year-old fracture patient was admitted to the Department of Orthopedics of Yangzhou Maternal and Child Health Hospital. After the old man slipped and fell at home, the pain in his right hip was unbearable and he could not walk. He was escorted by his family to the hospital for treatment. After examination, the diagnosis was “right femoral intertrochanteric fracture”.
Why does “intertrochanteric fracture of femur” love to target the elderly?
This starts with endocrine. With age, the level of human hormones gradually decreases, which affects calcium metabolism and calcium absorption, resulting in decreased bone mass and increased bone fragility. Usually, women in their 50s and men in their 60s develop osteoporosis, and they are prone to fractures after accidentally falling and being hit by external forces. With the acceleration of the aging process in my country, hip fractures in the elderly are increasing year by year. In addition, some patients with chronic diseases are also prone to osteoporosis due to long-term use of hormones.
Because “intertrochanteric fracture of femur” is more common in the elderly, and many cases choose conservative treatment after fracture due to various reasons, long-term bed rest often produces many complications: such as lung infection, urinary Department of infection, lower extremity venous thrombosis, bedsores… any of these conditions may lead to life-threatening. Therefore, the “intertrochanteric fracture of the femur” is also called “the last fracture of my life”.
Is it possible to operate a fracture in the elderly?
In fact, if there is no obvious contraindication to surgery, as long as a systematic examination and adequate medical preparation are done before surgery, surgery may be the best treatment plan. At the same time, the elderly patients must be fully evaluated before surgery: first, the tolerance of surgery and anesthesia; second, whether the underlying diseases are under control; third, the possibility of postoperative infection and complications.
Operating on nearly 100-year-olds is a serious challenge for patients, their families, anesthesiologists and the entire medical team. After full communication, the family members fully understood the possible risks of anesthesia and surgery, and strongly expressed the elective surgery.
After comprehensive consideration, the department of anesthesiology adopted “single unilateral spinal anesthesia” which has little effect on the patient’s respiratory and circulatory function. Postoperative pain also has a certain effect on early getting out of bed after surgery and reducing complications.
Conclusion
A slight slip can cause the femoral neck, thoracic and lumbar spine of the elderly fracture. In the past, due to the relatively backward level of medical equipment and technology, the elderly were often treated conservatively for fractures, which were prone to secondary pressure ulcers, pneumonia, urinary tract infection, fracture malunion, etc., not only poor quality of life, but also high mortality. With the advancement of medical technology, this concept is quietly changing. Elderly people with fractures should go to the hospital for examination as soon as possible.
author
Ye Bin
Deputy Chief Physician. Engaged in anesthesiology clinical and research for 20 years, good at orthopedics, obstetrics and gynecology anesthesia.
Moderators
Xueyou Tao
Deputy Chief Physician, Medicine Doctor, master supervisor, director of anesthesiology department, deputy director of Yangzhou Anesthesiology Professional Committee, etc., engaged in clinical anesthesia work and research for 16 years, good at labor analgesia, pain diagnosis and treatment, critical and emergency obstetrics and pediatric surgery anesthesia treatment, Accumulated rich experience in critical emergency maternal first aid.