Management Strategies for Femoral Head Replacement Arthroplasty in Uremia Patients: Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 4, Issue 1
Abstract
To report the case of a patient with uremia who presented left femoral neck fractures due to osteoporosis caused by renal osteodystrophy. The special patient such as uremia with femoral neck fracture need a criterion for perioperative management and type of surgery. It is feasible to accept the total hip arthroplasty (THA) or hemiarthroplasty (HHA) for the femoral neck fracture patient [1]. Indeed, this therapeutic method has been also used for the particular patient with the sickle cell, Jehovah’s witness patients [2,3]. However, there are differences of management of perioperative period for uremia compared the above diseases in femoral neck fracture patient [4]. The purpose of this study was to report on 1 uremia patient who accepted the femoral head replacement due to min-trauma causing the left femoral neck fracture. Especially, to describe the Multidisciplinary management of perioperative period and clinical outcomes. Case Report This patient was a 51-year old woman (weight 50kg, height 155cm) who had left femoral neck fracture with uremia (Figures 1 & 2). She has been accepted the regular hemodialysis since diagnosed uremia. There were history of autologous arteriovenous fistulization of left radial artery and vein and nephrogenic osteoporosis. There was no history of allergy to medications or of any previous anesthesia-related problems. Results of cardiopulmonary function were within normal limits. Results of laboratory investigations were within normal limits, with a hemoglobin value of 119g/L, except of the renal function. The CT scans of left hip joint revealed the trans-cervical or sub-capital fractures of femoral neck (TSFFN) and dual energy x-ray proved the low grade bone mineral density (BMD). Reference to the ERAS for the THA and HHA with the optimal results [5,6], the management strategies for this patient included following items like multidisciplinary consultation and team work, suitable fluid management, effective antibiotics and prophylactic anti-coagulation, reduction renal anemia, regular hemodialysis, suitable analgesia, and early rehabilitation. Indeed, the minor adjustments were performed dependent on the results of routine examinations. Notably, the multidisciplinary consultation and team work consisted of the Department of Nephrology, Department of Hematology, Intensive care unit, Pharmacy Department, Anesthetist, Nurse, and Rehabilitative Physician. The work details of the above specialists were revealed by the following Table 1. The Kocher- Langenbeck approach was use for left hip hemiarthroplasty about 6th days. The regular examinations and appropriate adjustment were performed depending on the test results.
Authors and Affiliations
Yu Xie, Xu Biao Mao, Lun Li Xie, Jian Li, Jun Zhu, Biao Ming Huang, Fa Qin, Dan Pu
Keywords
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- EP ID EP590813
- DOI 10.26717/BJSTR.2018.04.001006
- Views 148
- Downloads 0
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