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Granny Part 2

The orthopedic surgeon examines an elderly woman who was found on the floor after a fall. On examination, her right leg is externally rotated, shortened, and painful to touch near the hip joint. X-rays confirm a fracture in the femoral neck. Due to the patient's poor nutrition and age, open reduction and internal fixation using prosthetic replacement is recommended to repair the fracture.

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710 views2 pages

Granny Part 2

The orthopedic surgeon examines an elderly woman who was found on the floor after a fall. On examination, her right leg is externally rotated, shortened, and painful to touch near the hip joint. X-rays confirm a fracture in the femoral neck. Due to the patient's poor nutrition and age, open reduction and internal fixation using prosthetic replacement is recommended to repair the fracture.

Uploaded by

roosteenee
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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Granny's Hip

Part 2. The attending orthopedic surgeon arrives and immediately suggests IV fluid replacement. As fluids and electrolytes come back into balance Granny informs the physician that she tripped on the throw rug in her apartment two days before being found by her grandson, and that she had been unable to crawl to the telephone for help. The orthopedic surgeon also confirms the resident's physical examination facts. She immediately orders anteroposterior and lateral radiographs of the hip region. Patient History: Upon examination the orthopedic surgeon notes the following:

The patient is a frail, elderly woman 75 years of age. She appears to be in rather poor nutritional state. Mentally she seems to be confused, which may be due to the effects of the narcotic and/or electrolyte imbalance.

Physical Examination: A physical exam by the surgeon yields the following information:

The right lower limb is externally rotated and the patient is unable to lift her right heel from the stretcher. The right leg is shorter, which is confirmed by measuring the distance between the anterior, superior iliac spine and the distal tip of the medial malleolus of the tibia, and comparing the results with those of the left lower limb (after passive rotation by the surgeon). The greater trochanter on the right side also appears to be higher and more prominent that that of the left thigh. Palpation yields tenderness in the femoral triangle in front of the hip joint.

Utilizing sound anatomical logic, consider the following questions: 1. What is your diagnosis of the patient? 2. Based upon the position of the lower limb, as well as the patient's nutritional history, if the hip is fractured what is the most probable location of the fracture? Provide adequate anatomical evidence to justify your answer to this question. 3. Based upon the patient's nutritional history, what other structures of the joint structure might be involved and in need of repair? 4. Keeping this patient's history in mind, which would be the best course of action: repair the fracture or prosthetic replacement of the femoral head? Defend your answer. 5. If open prosthetic replacement is required, what surgical procedure would be best for this patient? 6. Discuss the blood supply of the shaft, neck and head of the femur. Why should the orthopedic surgeon be aware of these anatomical details? 7. Utilizing sound musculoskeletal logic, why was Granny's hip in the position it was in when her grandchild found her? Because no active muscular action was involved in

placing her hip in this position, what passive forces would be involved in causing her limb to be laterally rotated?

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