86/m, fell down at home 2 days back. k/c/o alzhimers, dementia, HTN. h/o CVA, left PFN was done 3 yrs back. high risk for anaesthesia. kindly advise regarding management.

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in this age group operative fixation is better choice for early mobilisation of patient to avoid complication related to prolonged recumbancy. though high risk for surgery yet,sir i think discussion with relatives about risk benefit ratio and opt for surgery. pfn is better choice than dhs ,as less invasive .

Conservative management takes very long time for this kind of fracture to get union , by this time , patient might have risk of bed ridden complications like DVT, Pressure Sores in gluteal /sacral and heal regions, Hypostatic Pnemonia And prolonged immobilization complications like hip knee ankle stiffness,disuse osteoporosis And complications due to co morbidity Depression ,psychological changes To avoid all those listed risks Better operate the patient with highest risk and well informed consent Closed PFN with Shortest Anaesthesia with femoral nerve block / SA followed by early mobilisation of joints is ideal.

If she isn't fit then derotation boot and traction on it for a month. Then progressive Physio to attempt ambulation. This is generally a path to an early grave. Surgery would be PFN but then will she withstand, it depends on her physiological class.

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Another PFN 2 on this side

PFN with high risk Or NRB (non rotation boot)

Nèed to do another PFN right

Short pfn is ideal

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