Case 04

Question 1

Answer 1

Patient is a 74 yo community ambulatory with a PMH of COPD/Chrohns s/p fall from standing with an isolated right hip displaced femoral neck fracture.

no previous hip pain/nor arthritis

Answer 2

BMI-18

AVSS

grossly NVI RLE

Shortened ER wwp

TTP right hip

Question 3

Answer 3

Displaced right femoral neck fracture

Medically optimized

H&H 10.6/11.5/35/118

INR 1.1

BMP-WNL

Type and screened

Question 4

Answer 4

1. 48 hrs ED to Surgery-
2. Surgery strongly indicated for pain control/mobilization
3. bipolar hemiarthroplasty vs total hip
4. Cemented vs Non-cemented
5. Anterior approach with fluroscopy afterhours

Question 5

Answer 5

Supine position with Fluroscopy

TFL/Sartorius

ABLFCA tie off

GM/Rectus

Capsule

Press fit decision

Question 6

Answer 6

Lovenox

WBAT /Anterior precautions

judicious pain control–

Medical service/rehab pending

Question 7

Answer 7

1. PACU- NVI
2. POD1- Weak dorsiflexion
3. POD2 foot drop 3/5 Dorsiflexion/EHL intact

brace off/Flex knee HCT 33

4. Progresive neurologic decline in setting of hematoma and HCT drop. HCT 28

Question 8

Answer 8

Progressive RLE neurological decline in setting of HCT drop and hematoma on exam.

Knee brace removed

no spinal

negative ultrasound

normal xray

GO anterior- explore wound

Question 9

Answer 9

Continued Foot drop at 2 weeks

Neuro consulted-rec EMG

Hospitalized with respiratory issues

Covid

Not able to leave nursing home

Telemedicine at 3M

Question 10

Answer 10

8M foot drop resolved

Rx walker

Follow-up as needed