Diagnosis and Management?

87 year old male. Diabetic, hypertensive with COPD, CLD, CKD. Came with h/o RTA few hours before presentation. Along with selevral lacerations and contusions, swollen right upper thigh. GCS = 15 CBS = WNL SGPT n SGOT = above 2000 S. Creatinine = 3.6 So what does the xray tell us and how to go about managing this case?

(Edited)

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Fracture at the junction of femoral neck and greater trochanter - Type 1 fracture. Considering a CLD , CKD and COPD - conservative treatment can be thought off . But under spinal anesthesia ORIF ( open reduction - internal fixation can be done)

Thank you doctor. Valuable opinion.
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But the best treatment is Dynamic hip screw...After surgery, patients typically need to use a walker, crutches, or a wheelchair. While the break is healing, the patient is typically instructed by their doctor to place as much weight on their broken hip as is comfortable.

Thank you Doc
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It's may be IT Fracture of femoral neck Rule out liver pathology hemarhrosis around hip leads to swelling Creat was also increased meanwhile Correlate with history Look for hb because of vessels injured nearby neck of femor Nutritional support Replace blood products Hip replacement surgery need to done depends on condition Might be helpful ,👍

Thank you Doctor
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It is a case of trochanteric fracture neck femur. Ideally it is case of fixation with DHS but considering the age with a number comorbities it may be thought to go for conservative treatment but confinement to bed for almost three months with all these problems or will land to complication related to comorbities then considering all post operative complication if DHS can be done pt may be made ambulatory within ten days even with wheel chair. So considering all odds I would suggest for internal fixation with DHS then comorbities care may be taken of.

Post traumatic Intertrochanteric femoral fracture with break in shenton's line.... Multiple comorbidities with age of 87 requires great caution but ORIF may be tried

Treatment is by operative pinning with three parallel cannulated screws placed adjacent to the femoral neck cortex.

Intertrochanteric fracture Possibly acetabular fracture CT evaluation and proceed

Thank you Doctor
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IT fracture of femur Need CT to rule out acetabular fracture Surggery- PFN Orthopedician opinion is must

Diseases Related to Discussion

Copd
Hemarthrosis