ABSTRACT
Intertrochanteric fracture is a prevalent condition among older adults, and it is becoming more so as the population is aging. A 52-year-old man was reported to the hospital with symptoms of pain and swelling in the right hip since the morning. The patient reported a history of unexpected slips and falls in the morning. An X-ray was taken of both hips, and an intertrochanteric fracture was identified. After one month post-fracture, a dynamic hip screw (DHS) was used to perform open reduction internal fixation (ORIF). Early mobility, appropriate lower limb strength, pain reduction, and quality of life are all significant determinants. As evidenced by statistically significant improvements in exercise capacity and well-being, the intertrochanteric fracture rehabilitation program is beneficial. This case study represents a comprehensive rehabilitation program for people who have had post-fracture surgery.
ABSTRACT
Aim: Patients undergoing surgical repair of neck-of-femur (NOF) fractures are at higher risk of acute kidney injury (AKI). NICE and BOAST have published guidelines to help prevent the occurrence of AKI, including adequate fluid resuscitation pre- and post-operatively. An audit was conducted during the COVID-19 pandemic to explore whether the department was adhering to NICE guidelines. Method: AKI was defined, as per NICE Clinical Knowledge Summaries, as an increase in serum creatinine levels by 26 μmol/L or greater. Data was collected prospectively starting from December 2020 to February 2021 in the Princess Royal Hospital during the COVID-19 pandemic. All patients with NOFs were included and data on sex, age, comorbidities, and type of surgery were collected. Results: In total, 32 patients were included in the audit with an average age of 82 years;of these, eleven patients had dynamic hip screws and eighteen patients had hemiarthroplasties. Five patients had chronic kidney disease, six patients had previous myocardial infarctions and thirteen patients had hypertension. Two patients (6.3%) were found to have an AKI post-surgery with increased creatinine levels of 27 and 28 μmol/L. Both had hypertension and underwent hemiarthroplasties. Conclusions: Complications such as AKIs are reversible and preventable. Especially during the COVID-19 pandemic such complications can increase morbidity and mortality of patients suffering from NOF leading to longer hospital stays. The low rate of AKI following NOF repair in our Department of Trauma and Orthopaedic is attributable to adherence to NICE and BOAST fluid resuscitation guidelines.