Fortis Hospitals Mulund doctors give new life to octogenarian with DVT and severe hip fracture in the same leg

~Minimally invasive surgery done resulting into no blood loss and early discharge~

Doctors at Fortis Hospitals, Mulund, Mumbai recently treated an exceptional case of DVT (deep vein thrombosis) and hip fracture in the same leg of an obese octogenarian lady.

Mrs. Godavari Vagad, an 84yr old obese lady had fallen while walking and fractured her left hip. She also had Deep Vein Thrombosis of the left leg. Doctors at a general hospital in Thane found her condition very critical and referred her to Fortis Hospitals, Mulund (formerly Wockhardt hospital).

Highlighting upon the case, Dr Milind Sawant, Consultant Orthopedic Surgeon, Fortis Hospitals said, “We faced key challenges like advanced age, obesity, osteoporotic bones and pre-existing DVT, all at one go. These implied difficulty in operative procedure and fracture reduction. Osteoporotic bones made fracture fixation challenging. Also, the presence of DVT in the leg to be operated increased the risk of the clot breaking up and embolising during fracture fixation and so fracture manipulations would have to be done carefully. Hence we had to consult a cardiologist before finalizing the line of management.”

Dr Hasmukh Ravat, cardiologist said, “What makes this case rarest of rare is the introduction of IVC filter (Inferior Vena Cava) implantation. A filter was put into the Inferior Vena Cava pre-operatively so that even if the blood clot was to break off and flow towards the lung, the filter would trap it before it would compromise the lung circulation.”

After insertion of the IVC Filter, the patient was taken for the orthopedic line of treatment :
“Minimally invasive technique of per-cutaneous insertion of Proximal Femoral Nail (device) was used to fix the fracture without opening the fracture site – which meant minimal blood loss (and therefore no need for blood transfusion), minimal tissue trauma (and therefore less pain and faster recovery) and no disturbance of the fracture hematoma (which meant early fracture healing without need for bone-grafting). A high-frequency, high resolution C-arm Image Intensifier (machine) was used which gave clear images of the fracture fragments and made fracture reduction and fixation easy and accurate said Dr. Sawant.

In addition to the above, a titanium implant was used to fix the fracture, whose modulus of elasticity is closer to that of bone. The device is light but extremely strong to take the weight of this obese patient. Being an intra-medullary device it was biomechanically superior to take the stresses and strains at the fracture site till the fracture unites. This allowed early mobilization of the patient out of bed and early discharge, he said.

The recovery was uneventful and patient was discharged after few days.