Girdlestone Procedure Hip Fractures Elderly - Everything You Need To Know - Dr. Nabil Ebraheim

Описание: Dr. Ebraheim’s educational animated video describes the use of Girdlestone procedure in displaced hip. fractures in the elderly
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Girdlestone Procedure for Femoral Neck Fractures in the Elderly
Girdlestone procedure is a salvage procedure. It means removal or resection of the neck of the femur. The diseased femoral head is cut off with a bone saw. It means removal or resection of the head and neck of the femur. The affected femoral head is removed as you can see in this picture. Girdlestone is usually done in the following situations: patient has a severely painful hip and a total hip replacement cannot be done such as in cases of severe infection of the hip or in a nonabulatory cerebropalsy patient with a painful hip dislocation. It can also be done in selective tumors of this area. The procedure is referred to as a “salvage” procedure. It is the lesser of two evils or it is the final alternative procedure. This procedure may have a role in cases of displaced femoral neck fractures or in cases of failed internal fixation of femoral neck fractures in debilitated elderly patients. Let’s agree that in the elderly patient, hip prosthesis either unipolar or bipolar and usually cemented, is the ideal surgical procedure for displaced femoral neck fractures, especially if the patient is debilitated and old. In an active elderly patient, total hip replacement should be considered. Sometimes the medical condition and the age of the patient does not support or allow the use of a prosthesis in the elderly. I use the girdlestone procedure in some cases of displaced femoral neck fractures in the elderly, especially if the patient is debilitated and nonambulatory, and when the medical comorbidities are almost prohibitive for surgery. Comorbidities include chronic renal failure, COPD, and congestive heart failure. Even if the prosthesis could be done, the pre-injury cognitive and physical function is predictive of post-operative functional outcome after hip fracture surgery and this select group of patients will not be functional with the prosthesis. The purpose of the Girdlestone procedure is to decrease the pain and to preserve the life of the patient despite the considerable shortening of the extremity. It is an alternative to hospice or alternative care. It is the simplest and the least complex procedure for the patient. Counseling to the patient and the patient’s family should be done. The Girdlestone procedure can be done anteriorly or posteriorly. You do not need traction post-operatively. You should get the patient out of bed immediately, and you should do physical therapy early. You will keep the patient in a step down or ICU for a few days after surgery. The patient should be admitted by the geriatric services in cooperation with the trauma services. Surgery should be done within 48 hours or as soon as the patient is optimized medically because that could decrease the mortality rate. Sometimes optimization of the patient is not that easy. The mortality rate is 25% at one year and 6% during hospitalization. The pre-injury mobility is the most significant determining factor for post-operative survival. In patients with femoral neck fractures, surgery done on weekends was associated with an increase in hospital mortality rate, so it is better to do this surgery on week days. If you try to do a simple procedure such as fixation of the displaced femoral neck fracture, the failure rate is about 46% with fixation techniques in the elderly. There is a growing number of people over 90 years of age who will suffer from femoral neck fractures and these patients will need decisions and appropriate care for their situation. Advanced age is associated with increased mortality and poor functional recovery, so we need to think of new ways to approach the increased number of femoral neck fractures in the elderly, and I think that Girdlestone procuedre should be utilized in some select indications.