Approach to patients with hip fracture and concurrent stroke

Abstract

We report a case of a 70-year-old man who presented with concomitant hip fracture and stroke. Our patient underwent surgical correction of a hip fracture despite the increased perioperative and postoperative risks associated with an acute stroke. He achieved good functional outcome after surgery and subsequent rehabilitation. There are no clear guidelines on the factors to determine whether a patient with concomitant stroke and hip fracture is a good candidate for surgical hip repair. Furthermore, there is also no consensus on the appropriate timing of surgical repair for such patients. We postulate that factors such as functional status, comorbidities, type and severity of stroke will affect the decision to proceed with surgical repair, and that there is a benefit in advocating for surgery in appropriate patients by a multidisciplinary orthogeriatric care team.

Keywords: geriatric medicine; orthopaedic and trauma surgery; orthopaedics; stroke.

Figure 1

(A) T2-weighted MRI diffusion-weighted imaging done on admission showing a small focus of restricted diffusion in the right corona radiata. (B) Radiograph of right hip showing a minimally displaced right intertrochanteric fracture. (C) Radiograph of right hip after right proximal femoral nailing.