|
Hospi News
Fortis Gives New Life to Octogenarian with DVT
Introduction of Inferior Vena Cava filter implantation
made it rarest of the rare case
The patient (in centre) post surgery |
Doctors at Fortis Hospitals, Mulund, Mumbai recently treated
an exceptional case of Deep Vein Thrombosis (DVT) and hip fracture in the same
leg of an obese octogenarian lady.
Godavari Vegad, an 84-year-old obese lady, had fallen while walking and fractured
her left hip. She also had DVT 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).
Said Dr Milind Sawant, Consultant Orthopaedic Surgeon, Fortis
Hospitals, Mulund, "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 finalising the line of management."
Added Dr Hasmukh Ravat, cardiologist, "What makes this case rarest of rare
is the introduction of IVC filter (Inferior Vena Cava) implantation. A filter
was put into the IVC 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 orthopaedic 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 mobilisation
of the patient out of bed and early discharge,” added Dr Sawant.
EH News Bureau
|
