What is the most appropriate management for a 70 year old woman with extracapsular fracture of the neck of Femur?

What is the most appropriate management for a 70 year old woman with extracapsular fracture of the neck of Femur?

The most appropriate management for a 70-year-old woman with an extracapsular fracture of the neck of the femur (also known as an intertrochanteric or subtrochanteric fracture, depending on the exact location) typically involves surgical intervention. The goals of treatment are to relieve pain, restore mobility, and minimize complications. Here are the key management steps:

Surgical Options

  1. Internal Fixation:
  • Dynamic Hip Screw (DHS):
    • Commonly used for stable intertrochanteric fractures.
    • Involves placing a large screw into the femoral head, which is connected to a side plate along the femur.
  • Intramedullary Nail (IM Nail):
    • Often preferred for unstable intertrochanteric fractures or subtrochanteric fractures.
    • A rod is inserted into the medullary cavity of the femur, providing internal support and stabilization.
  • Proximal Femoral Nail (PFN):
    • Similar to an intramedullary nail but specifically designed for proximal femoral fractures.
  1. Hemiarthroplasty or Total Hip Arthroplasty:
  • Considered for patients with pre-existing hip arthritis or in cases where internal fixation is unlikely to provide good outcomes.
  • Hemiarthroplasty involves replacing the femoral head with a prosthesis.
  • Total hip arthroplasty replaces both the femoral head and the acetabulum.

Non-Surgical Management

  • Non-surgical management is generally not recommended for extracapsular femur fractures in elderly patients due to poor outcomes and high complication rates.
  • It may be considered in non-ambulatory patients with multiple comorbidities where the risks of surgery outweigh the benefits.

Postoperative Care

  1. Early Mobilization:
  • Mobilize the patient as soon as possible to prevent complications such as deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, and pressure ulcers.
  • Physical therapy to assist with rehabilitation and gait training.
  1. Pain Management:
  • Adequate pain control is essential to facilitate early mobilization and rehabilitation.
  1. DVT Prophylaxis:
  • Use of anticoagulants (e.g., low molecular weight heparin) and mechanical prophylaxis (e.g., compression stockings).
  1. Nutrition and Hydration:
  • Ensure adequate nutritional intake to support healing.
  • Manage hydration status to avoid complications related to dehydration or fluid overload.
  1. Monitoring for Complications:
  • Regular follow-up to monitor for potential complications such as surgical site infection, hardware failure, and non-union of the fracture.

Conclusion

For a 70-year-old woman with an extracapsular fracture of the neck of the femur, the most appropriate management is usually surgical intervention. The choice between internal fixation and arthroplasty depends on the specifics of the fracture, the patient’s overall health, and pre-existing conditions. Early mobilization and comprehensive postoperative care are crucial to achieving the best possible outcome.