Musculoskeletal case studies for medical students

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History

An 82 year old lady fell in the bathroom.

She complained of left hip pain. She had been ambulant and a house walker. No other injuries.

Senile dementia, hypertensive, no other major illnesses.
Initial X ray
Description AP X Ray Pelvis
X ray
Description X Ray- detailed view
Problem The 82 year old female with a painful left hip after falling in the bathroom. How this was treated, and why.
X ray after treatment
Description X Ray after Moore's Prostheisi
Post management further view
Description
Classification There is an intracapsular fracture of the left proximal femur. The fracture is displaced.
Discussion of management The patient was admitted and given intravenous fluids. After a thorough check up for other medical problems she was taken to theater the next day. A Moore's hemi prosthesis was inserted. Because the fracture was displaced and its intra capsular position the viability of the femur was tenuous. Some form of replacement, rather than direct fixation was indicated. Because she was senile, physiologically old and was not a community walker, it was decided to insert a Moore's hemi prosthesis, rather than a total hip replacement. Active healthy patients from 55 years and older get a total hip replacement for displaced intra capsular fractures. Only patients who are chronically ill, demented or otherwise have a very limited life expectancy qualify for a hemi prosthesis. A Moore's involves a smaller operation and is cheaper. If the fracture is undisplaced ORIF with cannulated hip screws is more appropriate.

 

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