HIP STUFF!


Old people keep falling for a variety of reasons. They see things as if through a windshield on a rainy day when the wipers have lost their rubbers. They have creaky joints, powdery bones, and thin muscles to support them, as a result of age-related misuse and disuse. The resultant lack of balance makes them vulnerable to slipping on a bathroom floor or dog poo. It is also important to realise that these often lovable (and sometimes unlovable) ancient relics can lose consciousness for a variety of reasons: cerebral ischemia (called a TIA), heart block, low blood glucose, etc). Once the patient is discovered lying on the floor, they are often unable to say clearly whether they slipped and fell, or flipped and fell! Sometimes, they are picked up from the floor, and carried to bed, where they are kept ‘in rest’ for a week or more. It is when the patient becomes sick that an alert doc picks up the fracture in the neck of the femur by noting the laterally rotated foot on the bed. This means that when a patient lies flat in bed, normally her great toes would point to the GoogleEarth satellites far overhead. If they point towards the TV or the fridge, the hip is liable to be broken (real medical Holmes stuff, eh?). By the time the fracture is detected, the patient is already having urinary and lung infections, and taking blood-thinners and a dozen different drugs. In short, not the kind of patient an orthopedic surgeon will knife his competitor to take up!
There is evidence that surgery for fixing the broken bones leads to good results, as this excellent summary shows. However, it is important to postpone the surgery for a while to prepare the patient for surgery. Mortality is more if patients are wheeled straight to the operation theater from the Emergency Room. Should we, as our beautiful Nurse asked in her comment, operate on these ‘fossils’ only to make see them lie in bed, vegetatively incontinent and incoherent? Studies show that while conservative treatment is successful, it leads to longer convalescence and hospitalisation. No surprise, that! The bottomline, in my semi-literate mind, would be that if the patient is demented, incapable of independent activities even at the basic level (eating, cleaning, etc.), or if the medical problems are very severe, they should be spared the rod. I am talking, of course, of the steel that orthopods insert into broken limbs. Only, these days, they are more likely to ‘screw’ the patients!

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