Post-Surgery Complications in Elderly Hip Fracture Patients: A Case Study

Post-surgery for intertrochanteric fracture dislocation, there is a concern regarding the distance between some bone fragments and medication issues?

An 83-year-old female patient, with no history of hypertension or chronic diseases, received a Moderna vaccine on July 4.
Three days later, she developed a fever but reported no other discomfort.
On July 10, she had no symptoms but visited the clinic as per the vaccination reminder.
The clinic refused to see her, so we went to the Taichung City Hospital emergency department, where they immediately treated her fever.
When we were about to be discharged, the emergency staff persuaded us to admit her to a private room for further investigation, which revealed multiple large stag-horn calculi in both kidneys.
On July 12, she fell in the internal medicine ward of Taichung City Hospital and lay motionless on the floor.
The family was hesitant to move her.
Nurses from the hospital came and, disregarding the family's objections, lifted her by her limbs to move her back to the bed.
However, they were unable to get her onto the bed and placed her back on the floor, resulting in an intertrochanteric fracture of the left hip and severe dislocation of the femur.
She underwent surgery on July 13.
She was discharged on July 23 and returned for a follow-up on July 26.
On the morning of July 27, she was found to have a right cerebral artery embolism, which was successfully treated at Taichung Veterans General Hospital.
Currently, she is at home.
Yesterday, she missed her morning medication after breakfast, and surprisingly, her long-standing leg swelling has subsided! This morning, I noticed that the medication bag indicated that Norvasc has a side effect of ankle edema.
The medications she is taking include Norvasc, Bokey, Plavix, Famotidine, Wanse, calcium acetate, Actein, and Eltroxin.
I am particularly concerned about the calcium channel blocker: while it lowers blood pressure and helps prevent another cerebral artery embolism, I wonder if it might delay the healing of her fracture.
Additionally, regarding the titanium internal fixation, the fragment of bone connecting the intertrochanteric area to the medial side of the femur is rotated and displaced far from the other titanium-fixed parts.
Without surgical intervention in the future, it seems unlikely that this bone fragment will naturally realign with the main portion for healing.
Should we request the physician to consider another surgery for this specific issue? I am deeply worried and feel helpless for my innocent mother.
I kindly ask for guidance from Dr.
E before our next appointment with the physician.

Clare, 80~89 year old female. Ask Date: 2021/08/14

Dr. You Dianqi reply Orthopedics

I would like to express my utmost respect for your heartfelt description, which clearly shows how much you care for and cherish your family.
It seems that just as one wave of challenges subsides, another arises.
My first thought after reading your message is that you have been through a lot, and so has your mother.
Regarding your concern about calcium channel blockers potentially affecting wound healing, there should not be any direct impact.
As for the bone fragment that has shifted significantly, would it be possible for me to see your mother's X-ray to provide you with a bit more advice? I wish for your mother's speedy recovery, and I commend your efforts during this difficult time.

Reply Date: 2021/08/14

More Info

Post-surgery complications in elderly patients, particularly those who have undergone hip fracture surgery, can be quite complex and multifaceted. In your mother's case, several factors contribute to her current health status and recovery trajectory.
Firstly, it is important to recognize that elderly patients, especially those around 80 years of age, are at a higher risk for complications following surgery due to a variety of factors including decreased physiological reserve, the presence of comorbidities, and the potential for polypharmacy. In your mother's case, she had no chronic illnesses like hypertension, which is a positive factor, but her recent health events, including the fall and subsequent surgery, have introduced new risks.

The incident of her falling while being moved by hospital staff raises concerns about the quality of care she received. Such incidents can lead to further injuries, as seen with her left hip intertrochanteric fracture and severe femoral displacement. The surgical intervention she underwent on July 13 was necessary to stabilize her fracture, but the recovery process can be complicated by several factors, including her age and the nature of her injuries.

Post-surgery, the risk of complications such as deep vein thrombosis (DVT), pulmonary embolism, infection, and delayed healing is heightened in elderly patients. Additionally, the medications she is currently taking, including Norvasc (a calcium channel blocker), can have side effects such as peripheral edema, which may explain the swelling in her legs. While Norvasc is effective for managing blood pressure and preventing further vascular events, it is crucial to monitor its effects on her overall recovery, particularly in relation to her surgical site.

Regarding the concern about the titanium fixation and the alignment of the fractured bone, it is essential to follow up with her orthopedic surgeon. If the bone fragments are not aligning properly, there is a risk of non-union or malunion, which could lead to chronic pain and functional impairment. The surgeon may recommend imaging studies, such as X-rays or CT scans, to assess the healing process and determine if further surgical intervention is necessary.

In terms of her current condition, the swelling in her legs could be a result of immobility, medication side effects, or a combination of both. It is advisable to encourage gentle movement and elevation of her legs to help reduce swelling. However, any significant changes in her condition, such as increased pain, changes in mobility, or new symptoms, should prompt immediate medical attention.

In summary, your mother's recovery from hip fracture surgery will require careful monitoring and management of her medications, potential complications, and the healing of her surgical site. It is crucial to maintain open communication with her healthcare providers, ensuring that any concerns are addressed promptly. Regular follow-ups with her orthopedic surgeon will be vital in assessing her recovery and determining if further interventions are needed. Your advocacy for her health and well-being is essential, and seeking a second opinion or additional consultations may provide further clarity and reassurance regarding her treatment plan.

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