Two Very Rare Case of Simultaneous Bilateral Intertrochanteric Fracture Operated in Single Stage - A Case Report.

Introduction: Unilateral intertrochanteric fractures are common injuries in elderly population. Simultaneous bilateral intertrochanteric fractures do occur but are very rare and only a few cases have been reported in the literature. Case Report: We report two cases with different modes of injury. Both cases were fixed in a single stage by proximal femoral nailing (PFN). The first case had multiple comorbidities and after 6 weeks of follow up, she suddenly expired at home due to medical issue. The second case is the only case reported with associated bilateral superior and inferior pubic rami fracture. PFN was done in a single stage and at 1-year follow-up, the patient was having a good functional outcome. Conclusion: Simultaneous bilateral intertrochanteric fractures are very rare injuries but these are potentially life-threatening with high morbidity. Quick assessment and early single-stage stabilization with proximal femoral nail give stable fixation and good functional outcome.

Early Reimplantation of Open Total Extruded Talus: A Case Report.

Introduction: Traumatic open total extrusion of talus without soft-tissue attachment and not associated with surrounding fracture is a very rare injury which requires very high energy impact. In literature, optimal treatment protocols are yet to be established. A few options described in literature are talectomy and tibiocalcaneal arthrodesis or reimplantation of talus which may be immediate or after some interval. Case Report: A 28-year-old female suffered road traffic accident and had total open extrusion of talus without soft-tissue attachment, and we managed it with thorough debridement of the wound, saline irrigation, and immediate reimplantation of the talus with stabilization by delta frame external fixator. Proper pre- and post-operative antibiotic coverage was given as per protocol. We did not face post-operative infection, wound complication, and until 12 months followed up, there are some signs of avascular necrosis of the talus but the good functional outcome. Conclusion: With this case experience, we suggest that this is the valid treatment protocol for total extrusion of the talus, and it will provide a better hindfoot mechanism, heel height, and the patient can resume his/her daily routine activity as early as possible.

Identification of factors contributing to the development of postoperative delirium in geriatric patients with hip fractures- A prospective study.

Introduction: Geriatric hip fractures are a major cause of concern globally and often a frequent reason for morbidity and mortality. Postoperative delirium (POD) is a frequent but often under-diagnosed complication, especially after a major hip surgery. Some of the factors that have been associated with POD are diabetes, high American Society of Anesthesiologists (ASA) grading, electrolyte imbalance, and blood pressure fluctuations. Malnutrition as a risk factor is only recently being recognized. Although there are many possible risk factors reported, they are quite conflicting and not very clear. Therefore, we have attempted to conduct this study to identify the potential risk factors for the development of POD in patients with hip fractures. Materials and Methods: A prospective observational study was performed on 110 geriatric hip fracture patients admitted to tertiary health care in South India. Data regarding preoperative blood investigations, ASA grading, hypertension and diabetes status, MNA (mini nutritional assessments) status, serum albumin, and serum electrolytes values were recorded. The Confusion Assessment Method tool (CAM) was used to diagnose delirium in the postoperative period. Statistical analysis was done for various factors influencing the occurrence of POD. Results: Among the total of 110 cases of geriatric hip fractures patients, 44.5% of the patients developed postoperative delirium. Advancing age, hypoalbuminemia, malnourishment, and uncontrolled diabetes played an important role to the development of post operative delirium in patients with hip fractures. Conclusion: Advancing age, hypoalbuminemia, malnourishment, and uncontrolled diabetes are strong predictors for the development of postoperative delirium in geriatric hip fracture patients. Since age is a non-modifiable risk factor, interventional strategies aimed at correcting modifiable risk factors like nutrition, serum albumin levels, and diabetes control play an important part in preventing delirium in the postoperative period in elderly hip fracture patients.MeSH terms: Hip Fractures, Postoperative Complication, Delirium, Nutrition Assessment, Serum Albumin.