Proximal femur fracture carries high risk of mortality and morbidity. In patients over 65 years of age it is as high as 23% within the first 6 months (R P Pitto. The mortality and social prognosis of hip fractures. Springer Berlin/ Heidelberg. Vol 18 number 2 / April 1994). In patients with known coronary artery disease, the mortality rate following orthopaedic operations is < 1% (Kim A Eagle, MD; Charanjit S Rihal, MD. Cardiac risk of non-cardiac surgery. Circulation 1997; 96:1882-1887). Clinicians find it difficult making decisions in these complex cases.
Figure 1. Preoperative lateral radiograph. Click for larger image.
In the case mentioned above, the patient presented with proximal femur fracture and myocardial infarction. The cardiologists treated him conservatively because the risk of intervention and surgery was higher than the surgery alone. The patient was well informed of the potential high risk of mortality in view of his underlying medical problems.
He disliked the conservative management of his fractured hip, by means of analgesia and physiotherapy. He was very keen to undergo the operation, as he wanted to get back on his feet and independent life. Hence he made his mind against all the odds.
Patient was prepared for the surgery and had a successful dynamic hip screw operation. Post operatively, there were no immediate complications and subsequently was transferred to a rehabilitation ward.
