Fracture Acetabulum in 81 yr old

[Harpal Selhi]

Dear All,

81 year old male, active professional was walking without support prior to trauma. He had a fall 2 days back due to be jerk by a large animal.

He is known hypertensive on Deplatt-A (antiplatelet drug and aspirin). Presented to us in shock, resuscitated with blood and platelet transfusions.

He has EDH, which is small and needs conservative management as per neurosurgical guidelines and fracture lat end clavicle.

I am attaching the images of x-ray and CT for his hip with fracture fo anterior coloumn and floor of the acetabulum.

Suggest line of management, likely result and also aims of management of such fractures at this age and in this category of cardiac patients.

Looking forward to your advise & opinion


Regards

Harpal
Dr Harpal Singh Selhi
Associate Professor,
Deptt. Of Orthopedic Surgery,
DMC & Hospital,
Ludhiana-141002  INDIA
Cell: +91-98150-22527
Fax : +91-161-4622527

[harpal selhi]

------ End of Forwarded Message

[prof eid]

Dear Harpal
As you know, some people at 81 could have a younger physiological age. Of course you are reluctant to operate because of the expected morbidity. However, if the man is fit for surgery (after medical and anaesthesia consultation) and consenting (written high-risk consent) to this major intervention, then go ahead and operate. I would suggest an ilioinguinal approach with a contoured plate to buttress the displaced Quadrilateral plate, and including a screw into the posterior column. Otherwise, maybe reduction of the central dislocation by combined axial and lateral traction under light anaesthesia, followed by skeletal traction, may be good enough for his needs.

Best of luck


Abdelsalam EID, M.D.
Assistant Professor Orthopaedic Surgery
Zagazig University, EGYPT.

[harpal selhi]

What are the thoughts and opinion of the house on Primary THR at this age.

Use head as graft, cage, cemented cup.

Regards

Harpal

[Dr Murali Poduval]

Harpal

Primary THR is a good option no doubt, but the antecedent risks would also be higher. It would be a more extensive procedure, more time consuming and more blood loss can be anticipated, even at primary THR, it is possible you may have to fix the acetabulum to enable acetabular implantation. I would say attempt a closed reduction, draw the head out and allow it to unite as best as it does. A late reconstruction may be less daunting. A personal opinion, there are people who can argue either way for primary or late reconstruction.

regards

Murali Poduval

Dr Murali Poduval
Associate Professor
Department Of orthopedics
Pondicherry Institute of medical sciences
Kalapet
Pondicherry

[Dino Aguilar]

I have never done a case like this.

I have a similar case, 65 that I did the acetabular colum reconstruction first and 6 months later proceed with total hip.

I will surf web to look for information.

Regards.

 

 

Dino Aguilar

Mobile 505-888-32132

Office 505-2255-6898

Hospital Metropolitano

Suite #306

dagu...@cablenet.com.ni

Blackberry PIN 208150D8

PO Box 2261

Managua, Nicaragua

[George Thomas]

Dear Harpal,

I would be very reluctant to immobilse an 81 year old in skeletal traction.

Look at the article by Kelly Lefaivre in Journal of Orthopaedic Trauma May/June 2009 pg 370-378 for a new approach to the anterior column and wall.

--
George Thomas,
Chief Orthopaedic Surgeon,
St. Isabel's Hospital,
Mylapore,Chennai 600004,
India.
Phone +91-44-24991081/82/83
Editor, Indian Journal of Medical Ethics,
www.issuesinmedicalethics.org
www.ijme.in

[harpal selhi]

Kindly send me the article on my personal mail ID if u have access

Regards

Harpal

[George Thomas]

Ok.

[amied...@gmail.com]

Pl send me a copy
Thanx

Sent on my BlackBerry® from Vodafone

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From: harpal selhi <hse...@gmail.com>

Date: Tue, 03 Nov 2009 13:15:32 +0530

[Sachin Bhonsle]

May I have a copy too George?

Dr Sachin Bhonsle MS(orth) ; FRCS
Senior Consultant Orthopaedic Surgeon
Wockhardt Hospitals
Mumbai
INDIA
tel + 91 9833852977

2009/11/3 <amied...@gmail.com>

[Praveen Rao]

Can I have a copy please?

Thanks

Praveen

[Ajmal Yasin]

Better to post it on orthopod so that every one interested can have a look on the said article.
 

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Date: Tue, 3 Nov 2009 13:14:18 +0530

Subject: [Orthopod] Re: Fracture Acetabulum in 81 yr old

From: george....@gmail.com
To: orth...@googlegroups.com

[george therthanath]

Ajamal,

The article should not be posted in the mailing list unless it is from a free resource. Posting of an article which is not from a free resource could endanger the list getting caught in copyright issues which could be quite messy from the legal point of view. So it will have to be sent on a person to person basis only.

Dr. T.I.George.

On Wed, Nov 4, 2009 at 8:07 AM, Ajmal Yasin <ajma...@hotmail.com> wrote:

Better to post it on orthopod so that every one interested can have a look on the said article.
 

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Dr George T Ittoop,
Sr Specialist, Orthopaedics,
Ibra Regional Hospital,
PO Box no: 3,
Postal code 400.
North Sharquia Region,
Sultanate of Oman.
Cell phone no: 968 95825197

[DR PANKAJ KUMAR]

a copy please

[Ajmal Yasin]

Please send a copy. Thanks
 

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Date: Wed, 4 Nov 2009 18:28:00 +0400

Subject: [Orthopod] Re: Fracture Acetabulum in 81 yr old

From: drtig...@gmail.com
To: orth...@googlegroups.com

[hani bassiooni]

please send a copy THANKS

[mohan desai]

Results  of primary THR in Acetabular#s-- A paper by Dana Mears in JBJS(A)
Dr. Mohan M Desai
 

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Date: Sun, 1 Nov 2009 23:30:15 +0530
Subject: [Orthopod] Fracture Acetabulum in 81 yr old
From: drha...@gmail.com
To: indi...@googlegroups.com; orth...@googlegroups.com; OR...@www2.aaos.org

[Hanume Gowda]

Sir

Can You please send a copy of the article on my mail?

Thanks in advance

Dr HanumeGowda

Bengaluru