Dubai: In a riveting case, an eminent orthopaedic surgeon from a Dubai hospital conducted a two-hour surgery to fix multiple fractures in the hipbone of an 88-year-old Indian woman and successfully carried out the procedure without a total hip replacement (THR).
This is a rare procedure as, usually, such complicated fractures require the entire hip joint to be replaced by a prosthetic, which was not possible in the case of this geriatric patient.
88-year-old had 21 fractures in hipbone
Recounting the case, Dr Ehab Shehata, orthopaedic surgeon at the International Modern Hospital told Gulf News, he was on emergency duty on May 6, when the Indian expatriate and Dubai-based entrepreneur, Saeeda Ahmed Wahab, was wheeled in with a left hip fracture.
An X-ray of and a CT scan of the pelvis showed she had 21 fractures in the hip region and she was admitted to hospital requiring urgent intervention. The challenge for Dr Shehata was Wahab’s medical condition. Dr Shehata explained: “The patient was not only advanced in age, with osteoporotic bones, but also suffered from diabetes, hypertension, cardiac issues, was thalassaemia minor, had a history of bilateral cancer and surgical double mastectomy 20 year ago, with a history of chemotherapy. Moreover, she had a total bilateral knee replacement for both knee joints 15 years ago. Looking at all these specifics, I discussed with the patient’s son, Zia Ahmed, that THR was not an option.”
Surgery with no hip implant
The next challenge was convincing the family to have a surgery conducted on the patient using fish bone grafts, Dynamic Hip Screws, to hold the fractured pieces together.
Zia Ahmed, Wahab’s son, who is a petroleum engineer and has considerable medical knowledge, told Gulf News he was surprised that the doctor and hospital were considering a surgery without a prosthetic. “Usually, prosthetics are expensive and a hospital would choose this option as it would translate into a huge bill. I was surprised that Dr Shehata, who has worked in German hospitals, wanted to follow German protocol and do away with using a prosthetic. Instead, he wanted to rely on my mother’s original joint. He spent hours convincing me why a prosthetic would not work in my mother’s case,” said Ahmed.
How did the fractures occur?
Describing the turn of events that led to his mother’s injury, Ahmed said: “My mother has been a very active person all her life. Typically, she walks 5km every day and she has been doing her weight training with a special geriatric physiotherapist. She loves using the swing in the villa and must have fallen off a dozen times. However, this time, a week before Eid on May 5, she got up at 2am to prepare for early Fajr prayers (she observes all the Ramadan fasts despite her advanced age). Somehow, she slipped on the steps, from the villa to the garden, and the right-angled edge of the stairs hit the hipbone that caused the fractures.
“However, despite so many fractures that we discovered later, because she had a high pain threshold, she bore the pain for the day. Due to the pandemic, I was apprehensive about taking her to the hospital. We had successfully kept her in a bio-bubble at home. However, after she spent the night in pain, and her physiotherapist opined that her left leg angle indicated there was a fracture, we decided to call in the ambulance and take her for initial investigations to the nearest hospital, which happened to be the IMH.”
Within the first 16 hours of observation, Dr Shehata decided to go ahead with the surgery. Usually, surgeries in such cases, if conducted within 24 hours, are said to have positive outcomes. Besides, Dr Shehata was concerned as the patient had shortening of her left lower limb and an external rotation deformity owing to the fracture. Immediate Surgical intervention was required.
‘Fracture patterns challenging to repair’
Dr Shehata said: “The radiological and clinical evaluation showed severe multiple unstable fractures from the pelvis to the hip joint, with lost cup-shaped socket of the hip joint about 5cm distal to part of the thighbone to which muscles are attached. Her fracture patterns were challenging to repair, owing to her age and comorbidities. Besides the patient had had bilateral total knee replacement, which meant we could not use the traction table. Being a diabetic and cardiac patient, the chances of developing deep vein thrombosis were also high. There was also a high chance of pulmonary embolism.”
He operated on the patient without a traction table and without stripping soft tissue, which is the usual procedure to fix fractures.
The surgery was successfully concluded within two hours and with minimal blood loss.
Wahab was discharged on the fifth day and was back again with the son, his wife and their two daughters. On the fifth day, prior to discharge, the patient was able to sit up and do assisted exercises.
It is more than a fortnight now and Wahab has recovered well. She is pain-free and able to use the walker without putting any weight on the operated hip or leg. She has been continuing the exercises and her family is delighted to see her up and about.