HIPZ on hips... This week's case comes from one of our Elective students:
On the ward round this week we were presented with an 80 year old woman who had come into hospital as she had fallen down and was now unable to walk. The patient appeared frail and in some pain but her observations were all normal. On examination her right leg was shorter than the left and was twisted to the side. This finding is very in keeping with a hip fracture, which would be a likely diagnosis given the sex and age of the patient - hip fractures are more common in older females as their bones are more brittle due to falling oestrogen levels. The patient also had right hip tenderness and so was sent for an x-ray to confirm the diagnosis.
As expected the x-ray showed a significant hip fracture, like the one shown in the picture below. A hip fracture is a serious injury in the elderly and without the correct treatment carries significant morbidity and mortality. Even in the UK where management of hip fractures is now heavily protocolised 10% of patients will die within one month and one third within 12 months. The only real treatment for a hip fracture is surgery; either a total or a partial hip replacement or fixation with screws.
The doctor contacted the orthopaedic surgeon at Mnazi Moja hospital in Stone Town and unfortunately for the patient there was no surgeons trained to carry out this type of surgery so she would have to be managed medically. This doesn't bode well for the patient as mortality rates are roughly four times higher without surgical intervention. Hip fractures take 6 or so weeks to heal, probably longer in this patient due to her frailty. And that's if they ever do heal. Sadly many patients like this will not be able to walk again and may have to remain bed bound for the rest of their lives.
Whilst the equipment involved in replacing hips can be very expensive, hip replacement or fixation are very commonly carried out surgeries with many orthopaedic surgeons trained to do them. With this in mind we can be hopeful that in the future patients on Zanzibar with hip fractures will have access to this potentially life saving and certainly life improving surgery.