"Advanced age" was once considered a surgical contraindication, but with advancements in medical technology and deeper multidisciplinary collaboration, this barrier is being progressively broken down.
Recently, our hospital successfully performed surgery on a 92-year-old, extremely elderly patient with an intertrochanteric fracture of the femur, complicated by severe cardiomyopathy and thrombocytopenia. Through systematic treatment and meticulous care, the elderly patient overcame numerous critical hurdles, is currently recovering well, and has been successfully discharged home.
Image for illustration purposes only
Accidental Fall Puts Nonagenarian in Critical Condition
92-year-old Mr. Chen accidentally fell at home, experiencing severe pain in the left hip and inability to move. He was diagnosed in the emergency department with a left intertrochanteric fracture of the femur.
This type of fracture is known as the "last fracture of a lifetime" for the elderly: conservative treatment requires prolonged bed rest, which can easily lead to fatal complications such as pulmonary infection, deep vein thrombosis, pressure ulcers, and urinary tract infections. The mortality rate within one year for elderly patients is extremely high. Early surgery and early mobilization are key to saving lives.
However, Mr. Chen's path to treatment was far more perilous than that of an average fracture patient.
Preoperative Examinations Reveal Successive Danger Signals
Preoperative examinations revealed successive danger signals:
Platelet count below normal, increasing the risk of bleeding during and after surgery;
Echocardiography indicated hypertrophic obstructive cardiomyopathy with a left ventricular outflow tract gradient of 151 mmHg, classified as severe obstruction (typically >50 mmHg is considered severe);
Anesthesia and surgery could easily lead to refractory hypotension, malignant arrhythmias, and even cardiac arrest.
Extremely advanced age combined with severe heart disease and coagulation abnormalities exponentially increased the difficulty and risk of surgery.
Multidisciplinary Teamwork to Overcome Challenges and Customize Treatment Plan
Faced with the complex condition, our hospital immediately initiated an MDT multidisciplinary consultation, with experts from Orthopedic Trauma, Cardiology, and Anesthesiology conducting a joint assessment.
The expert team unanimously agreed: without surgery, the elderly patient would be at risk of life-threatening complications from bed rest; although surgery was risky, it offered a chance to regain mobility. After thorough communication with the family, obtaining their understanding and trust, the team formulated a meticulous perioperative plan to ensure surgical safety.
Surgery Successful, Overcoming Critical Hurdles to Regain Life
With precise support from the Anesthesiology Department and continuous monitoring by the Cardiology Department, the Orthopedic Trauma team, led by Director Zhang Ying, performed a minimally invasive closed reduction and PFNA internal fixation for the elderly patient. The surgery went smoothly, and vital signs remained stable throughout the procedure.
On the first day after surgery, the patient was able to perform functional exercises in bed, with significant pain relief and no complications such as infection, thrombosis, or cardiovascular events. Following systematic rehabilitation, he can now sit up and move with the assistance of family members and was successfully discharged.
"I never imagined that at 92, with such a severe heart condition, the surgery could still be completed successfully. We are so grateful!" the family members said excitedly.
The successful treatment of this extremely elderly patient with an intertrochanteric fracture, severe hypertrophic obstructive cardiomyopathy (gradient 151 mmHg), and thrombocytopenia fully demonstrates the core value of the multidisciplinary team (MDT) diagnostic and treatment model in the surgical management of high-risk, complex elderly patients.
With the accelerating aging of the population, there will be an increasing number of surgical patients who are elderly or extremely elderly and have multiple underlying diseases. In the past, these patients were often deemed "surgical contraindications." Today, through scientific evaluation, precise perioperative management, and close multidisciplinary cooperation, age is no longer the sole determining factor.
Health Education by Director Zhang Ying, Orthopedic Trauma:
Intertrochanteric Femur Fracture: A High-Risk Fracture Requiring Vigilance in the Elderly
Author of this article >>> Heyou Pinnacle Medical Center General Practice | Cai Pengshan (Deputy Chief Physician)
Reviewer of this article >>> HeYou Hospital Orthopedic Trauma | Zhang Ying (Chief Physician)
(Due to individual patient differences, treatment outcomes may vary. Please consult a professional physician for specific advice.)
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